A census day audit of ment al health independent sector placements in the West Midlands
Authors:
Dr Tony Ryan Dr Barbara Hatfield Indhu Sharma & Dr Vicky Simpson
February 2005
‘A census day audit of mental health independent sector placements in the West Midlands’ 2 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Contents
Page 4 Acknowledgements
Page 5 Executive summary
Page 7 Terminology
Page 8 Background and references
Page 11 Aims
Page 12 Methods
Page 14 Recommendations
Page 18 Appendix 1 Response rate and numbers of cases across the West Midlands
Page 19 Appendix 2 Adjusted registered PCT, provider Trust and SHA populations (all ages)
Page 21 Appendix 3 West Midlands overview
Page 29 Appendix 4 Birmingham & the Black Country SHA area Adult placements Older people CAMHS Forensic
Page 64 Appendix 5 West Midlands South SHA area Adult placements Older people CAMHS Forensic
Page 97 Appendix 6 Shropshire & Staffordshire SHA area Adult placements Older people CAMHS Forensic
Page 131 Appendix 7 Data providers
Page 132 Appendix 8 Provider Trusts in the West Midlands
Page 133 Appendix 9 Data collection proforma
‘A census day audit of mental health independent sector placements in the West Midlands’ 3 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Acknowledgements
We are indebted to a number of people who have supported this project in many ways. In particular they are:
• Staff of the 45 organisations across the West Midlands who participated in developing the data collection proforma and diligently provided the data for the project.
• NIMHE West Midlands Regional Development Centre who sponsored the project, in particular Alastair McIntyre, Dr Ian McPherson, Gemma Parfitt and Gemma Boraston.
• Jennifer Wells at the Commission for Social Care Inspection
• Anthony Deery at the Healthcare Commission
‘A census day audit of mental health independent sector placements in the West Midlands’ 4 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Executive summary
• All 45 commissioners of secondary mental health services in the West Midlands were invited to participate in a census day (28th June 2004). This covered 30 Primary Care Trusts, 14 Local Authority Social Services Departments and the Specialised Commissioning Services Agency.
• The aims of the project included: – mapping all out of sector placements, – identifying characteristics people placed, – establishing expenditure, – providing baseline information for service and system development, and – stimulating collective action amongst commissioners in the West Midlands.
• Information was obtained for people placed in independent sector facilities registered with the Healthcare Commission or Commission for Social Care Inspection. All mental health groups were included except those with dementia funded solely by LASSDs in care homes.
• Response rates were high from the 45 organisations: CAMHS (100%, 45), adults (100%, 45) and older people (97.8%, 44).
• Important information was not known to commissioners in over 25% of cases in the following areas: – diagnosis, – legal status, and – suitability of placement
• The specialised commissioning agency provided the data for forensic services and had considerably less “don’t know” responses than other commissioners. The role of dedicated case managers for placements in the independent sector is likely to be a key factor in this.
• Less than 20% of placements were in the voluntary sector.
• Local Authority Social Services Departments funded the majority of placements while health commissioners provided the greater amount of funding.
• A total of 440 organisations were commissioned, 25 of which accounted for 41% of placements. A further 240 organisations provided only one placement each and accounted for 11.2% of all placements.
• The data points to a number of areas where collaborative commissioning could make a significant impact e.g. in managing high volume multiple contract providers, commissioning specialist services across SHA or the West Midlands for illnesses such as Korsakoff’s Syndrome and Huntington’s Disease.
• Over 50% of cases are in the Birmingham and the Black Country SHA area.
‘A census day audit of mental health independent sector placements in the West Midlands’ 5 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) • Many people are placed at geographical distance from area and services of origin.
• Based on the census day figures the expenditure of the year would be over £94M Birmingham and the Black Country = £43.6M; West Midlands South = £27.7; Shropshire and Staffordshire SHA = £22.7M)
• Descriptive statistics are used throughout this report and have not been weighted for direct comparison purposes. Future examination of the data will seek to undertake this form of analysis.
‘A census day audit of mental health independent sector placements in the West Midlands’ 6 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Terminology
Independent sector The “independent sector” is a term often given to non-statutory sector service providers and a range of terminology are used to describe this area, sometimes confusingly. For the purposes of this work the independent sector has been used as a term to cover both voluntary (charitable/not for profit) and private (profit making) sectors.
The West Midlands The geographical area covered by the following Strategic Health Authorities: Birmingham and the Black Country SHA, West Midlands South SHA and Shropshire and Staffordshire SHA.
Out of sector placement A placement into the independent sector made by commissioners of secondary mental health services.
‘A census day audit of mental health independent sector placements in the West Midlands’ 7 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Background
Mental health placements of people outside the area where they live and outside the geography of the local service commissioners (commonly referred to as “out of area treatments” – OATS) occur into statutory and independent sector services (voluntary and private). This is significant across the country and is of concern to many who are responsible for funding services. While these are often very useful many issues are raised in respect of quality, cost, appropriateness, monitoring, return of area of origin, distance from relatives, etc. (Poole et al, 2002; Ryan et al, 2004). A clear picture of the size of the expenditure and in particular the characteristics of some of the groups that are placed out of sector has not been available to date.
The past 20 years has seen the independent sector grow and develop considerably. It is now a major provider of services that were once almost exclusively delivered by statutory sector agencies (NHS and social services/Local Authorities). It has been estimated that there were 28,766 beds in 1,507 private hospitals and nursing homes in England in 2001 (this does not include voluntary sector), of which 196 were registered to take people under the Mental Health Act 1983 (DoH, 2002). This represents a significant number of service users. By contrast there were 32,783 NHS in-patient mental health beds available, of which 3,849 were classified as non-elderly “long stay” in 2001/02 (DoH, 2003a). Therefore, the private and voluntary sectors constitute a significant proportion of total psychiatric bed capability.
Additionally, 34% of secure psychiatric provision in England is now privately owned (DoH 2000/1). In October 2000 in England 491 patients were detained under the Mental Health Act in 10 private secure facilities (DoH 2000/1) and a total of 1,700 patients were detained in private mental nursing homes (DoH 2001). The growth in registered facilities as independent hospitals, care homes with nursing or care homes shows no sign of abating. By 31st March 2005 the Healthcare Commission estimate that there will be 229 Private and Voluntary Healthcare registered establishments with approximately just over 6,000 beds (Healthcare Commission, 2004).
In November 2004 there were 201 care homes and care homes with nursing registered in the West Midlands with the Commission for Social Care Inspection to support people with a mental illness and they provide 3,974 beds in total (Commission for Social Care Inspection, 2005).
Services delivered by the independent sector cover almost all the areas that NHS and Local Authority providers work in; from eating disorder services through to secure services. With a dispersed range of services many service users have been moved away from their families and communities and lost or damaged important relationships as a result. Many have also been excluded from their home communities and from local services.
Many stakeholders acknowledge that there is considerable variability in the independent sector. Some providers appear to have exploited the market and have not delivered services of an acceptable quality. Independent sector providers aiming to deliver high
‘A census day audit of mental health independent sector placements in the West Midlands’ 8 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) quality services have an interest in ensuring that poor quality services do not tarnish the reputation of the rest of the sector.
There are key differences between how private and voluntary sectors operate in relation to service development. Private sector organisations have the ability to responded to market opportunities where building based services can be financed with venture capital obtained from financial institutions. In contrast, the voluntary sector has usually responded to local needs and acquired capital through statutory agencies such as Local Authorities, the NHS or Housing Corporation to acquire property in which to run services. As a result the two approaches bring different relationships with NHS and SSD commissioners. Voluntary sectors providers have traditionally been seen as easier to work in partnership with as a consequence as their service developments are more likely to fit with the plans of commissioners.
Until now it has been difficult to obtain systematic data on people who require placement in the independent sector. Some commissioning organisations have good systems for recording and monitoring placements whilst others do not. Irrespective of the quality of information maintained at local level it is not collated in a manner that makes it easy to aggregate and view a wider perspective.
Part of the perspective is to maintain an eye on the growth of the independent sector and encourage development based on need determined through effective commissioning. However, as things stand there is nothing to prevent any provider from establishing a facility so long as it meets the requirements of regulators such as the Healthcare Commission or Commission for Social Care Inspection. The suitability to fit within a local whole system or its integration within such a system is not an area of concern to regulators.
In order for commissioners to develop and commission services to meet the needs within and across their local communities strategic strategically useful information is necessary to inform service and system design across. Hopefully this work will provided the basis for supporting a range of initiatives that ensure closer working relationships between service commissioners, NHS and LASSD clinicians and practitioners and provider organisations.
Finally, and interestingly, many of the issues highlighted here in relation to mental health also have a similar resonance with the learning disabilities field (Brindle, 2004; Cooke & Carpenter, 2002; Jaydeokar & Piachaud, 2004).
References
Brindle, D. (2004) Private care for learning disabled people is a return to Victorian values. Guardian Newspaper 4th August 2004.
Commission for Social Care Inspection (2005) Personal communication.
Cooke, L.B. and Carpenter, P. (2002) No lessons learned. British Medical Journal Rapid Response. 23 August. (http://bmj.bmjjournals.com/cgi/eletters/325/7360/349#24874)
‘A census day audit of mental health independent sector placements in the West Midlands’ 9 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Department of Health (2000/1) Medium secure service map and summary reports. (Version 2) Manchester: AFH Research Limited.
Department of Health (2001) In-patients formally detained in hospitals under the Mental Health Act 1983 and other legislation, England: 1990-1991 to 2000-2001. Statistical Bulletin 2001/28. London: Department of Health.
Department of Health (2002) Community care statistics 2001: Private nursing homes, hospitals and clinics. Statistical Bulletin 2002/09. London: Department of Health.
Department of Health (2003a) Average daily number of available and occupied beds by sector, England, 2001-02. (http://www.doh.gov.uk/hospitalactivity/data_requests/download/beds_open_overnight/b ed3_02.xls)
Department of Health (2003b) Compendium of Clinical and Health Indicators: Clinical and Health Outcomes Knowledge Base.
Healthcare Commission (2004) Personal communication.
Jaydeokar, S. & Piachaud, J. (2004) Out-of-borough placements for people with learning disabilities. Advances in Psychiatric Treatment. 10; 116-123.
Poole, R., Ryan, T. & Pearsall, A. (2002) The NHS, the private sector, and the virtual asylum. British Medical Journal. 325, 349-350. (17 August)
Ryan, T., Pearsall, A., Hatfield, B. & Poole, R. (2004) A pilot study of out of area placements for serious mental illness in the private sector. Journal of Mental Health. 13, 4, 425- 429.
‘A census day audit of mental health independent sector placements in the West Midlands’ 10 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Aims and outcomes of the project
A range of aims were identified at the start of the project:
• To map the extent of all out of sector placements across the NIMHE West Midlands footprint. • To identify the characteristics of all sub-groups within this population. • To establish the expenditure as it relates to the total population, subgroups within it and the sectors within which they are placed. • To provide a baseline report that can contribute to NIMHE West Midlands service and system development programme in this area. • To establish the regional database of independent sector providers. • To identify local learning and development needs. • To promote learning about complex individuals placed within complex systems. • To inform national initiatives for developing the role of the independent sector in mental health care.
‘A census day audit of mental health independent sector placements in the West Midlands’ 11 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Methods
Approach All Primary Care Trusts (PCTs, n = 30) and Local Authority Social Services Departments (LASSDs, n = 14) in the West Midlands were approached to participate in a census day data collection for all out of sector placements (i.e. into the voluntary and private sectors). The Regional Secure Commissioning Team was also invited to participate in the project. All 45 organisations signed up to participating in the project.
A data collection proforma (see Appendix 9) was developed through six stages using feedback gained from circulating drafts via email three sessions where West Midlands commissioners participated directly in the process of data collection design.
A census date of 28th June 2004 was agreed with commissioners and proformas were distributed in both hard copy and electronic formats. Data returns were followed up until 3rd November 2004 and data was entered into SPSS for analysis.
Inclusion criteria The study included all individuals in placements that were:
• placements in facilities registered with the Healthcare Standards Commission or Commission for Social Care Inspection as Independent Hospitals or Care Homes including Care Homes with Nursing (i.e. private and voluntary sector placements only) • include Forensic and CAMHS placements meeting the above criteria • include placements outside and inside the geographical boundary of the commissioner • all age groups except people over 65 with organic illnesses funded solely by Local Authority
And who fall into one of the following groups:
• mental illnesses and personality disorders • early onset dementias (e.g. Korsakoff’s Syndrome, Pick’s Disease) • acquired brain injuries (where paid for from a mental health budget) • autism / Asperger’s syndrome
Individuals with a sole diagnosis of learning disability or with a primary drug and alcohol problem were excluded. All people who were admitted and discharged on the day of the census (28th June 2004) were included in the study.
Data was collected in a range of areas including commissioner(s) details, client demographics, appropriateness of placement, care co-ordination, feedback to commissioner, Mental Health Act status, type of placement, finances and the service provider.
‘A census day audit of mental health independent sector placements in the West Midlands’ 12 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Preliminary data was presented to a meeting of commissioners in order to involve them in the process of analysis with the meeting generating a wide range of questions they would like the research team to attempt to address in the analysis.
Ethics approval The study was approved (as audit) by the North West Multi-centre Research Ethics Committee, and the Ethical Committee of the University of Manchester prior to commencing the project.
‘A census day audit of mental health independent sector placements in the West Midlands’ 13 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Recommendations
Whole system issues • There are many whole system issues raised by this work relating to scale, cost, links between agencies and variable information systems upon which to plan service and system development. A regional programme of support for commissioners and providers should be established across the West Midlands led by NIMHE and the three SHAs. It should involve commissioners, independent sector and statutory providers.
• In many cases a number of commissioners are using the same provider. Collaborative commissioning could be encouraged and supported by the Strategic Health Authorities and NIMHE. This should take on the task of lead commissioning for facilities where a number of commissioners are purchasing placements in a single facility (or with a single organisation). The lead commissioner could monitor the facility and negotiate block contracting arrangements.
• Collaborative commissioning could also explore opportunities for new developments based on the data presented here. For example, there are 19 cases of Korsakoff’s syndrome within the Birmingham and the Black Country SHA, 18 in West Midlands South SHA and 14 Shropshire and Staffordshire SHA. This is a life long condition and there is no specialist facility in the West Midlands. Traditionally people with Korsakoff’s syndrome are placed in facilities that cannot meet their needs. There is an opportunity to collaboratively commission a specialist service for these people.
• Guidelines for contracts (including service specifications, clinical governance, quality assurance and outcomes) are under-developed. A system of designing templates for contracts that can be used by commissioners (with local editing) is to be commissioned by the NIMHE RDC. Commissioners should take an active part in a working group aimed at providing examples of contracts and developing sample contracts that can be shared.
• There is limited joint working between the independent sector and commissioners (particularly with the prate sector) across SHA footprints. SHA forums involving commissioners, the main providers and regulators (i.e. Healthcare Commission and Commission for Social Care Inspection regional officers) could be established with the aim of closer working as a service system. The SHAs, NIMHE and Mental Health Act Commission could also be usefully involved.
Linkage between agencies • Feedback between commissioners, Care Co-ordinators and providers of placements is extremely variable. Each NHS provider Trust and their local commissioners should review their arrangements for co-ordinated feedback and the use of Effective Care Co-ordination in their area.
‘A census day audit of mental health independent sector placements in the West Midlands’ 14 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) • A system of ensuring contact between the three parties to share information should be established within each area (probably based on NHS provider Trust footprints). For governance purposes the process of information exchange should be audited regularly by commissioners.
• Many commissioners do not receive feedback from providers of placements. Commissioners should consider written feedback (perhaps on a six-monthly basis) from placement providers as a contractual requirement.
• Across the system of commissioners, NHS provider Trusts and independent sector providers there was considerable evidence of disconnection. Good practice guidance for each of these three components of the mental health system should be developed in order to clarify roles, expectations and practice issues. The NIMHE RDC should consider facilitating such a development. An annual commissioners ‘conference’ with providers (statutory and independent sector) to share plans and priorities should be considered in order to engage providers (and assess their level of engagement).
Linkage within agencies • Many commissioners were unaware of the money they were spending placements. Finance departments within PCTs and LASSDs should have processes in place for providing regular financial information to commissioners. Linkage between commissioners and finance departments will prevent PCTs and LASSDs paying for placements after the person has moved on or died. In a number of cases our project stimulated the commissioning organisation into identifying such situations.
• Within commissioning organisations there is variable contact between commissioners of different but related services (e.g. CAMHS, adults, older people, etc). PCTs and LASSDs should review how information about the commissioning process is shared internally for learning purposes and to improve governance (financial and clinical).
• Many participants on this project found the exercise useful as a way of reviewing their internal monitoring processes of independent sector placements. PCTs and LASSDs should consider setting up formal review mechanisms.
• Many people are geographically distant from their area of origin. This impacts on their ability to maintain relationships with key people in their lives (i.e. family and friends) and also makes monitoring by Care Co-ordinators and commissioners difficult. Consequently some people can be “lost to the system”. Active programmes of reviewing those people placed furthest away should be considered by Care Co- ordinators and commissioners and plans made where appropriate to ensure that support is provided nearer to their family and friends.
• Care managers within the Specialised Commissioning Agency have a specific role devoted forensic clients placed in the independent sector. This study identified that this client group was the one with significantly less “don’t know” responses in a range of areas. This model of managing clients should be considered for other ‘A census day audit of mental health independent sector placements in the West Midlands’ 15 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) groups, in particular those who are placed at significant distance from the funding authority.
Information systems • During the project we identified that a significant amount of important data was not available within local recording systems (e.g. diagnosis, ethnicity and legal status of the person and the suitability of the placement to their needs). Consideration should be given locally between commissioners and Care Co-ordinators about how best to address this.
• A basic standard data set should be agreed across the West Midlands in order to facilitate monitoring of change in use of the independent sector in the West Midlands. During this project we have found that many commissioners use paper- based systems to monitor placements. Information is particularly poor amongst commissioners of older people’s placements. A pilot database has been developed by Manchester University which will be distributed to all participants in this project and will be made available on the NIMHE NW RDC website. The database could be trialled and developed by commissioners across the West Midlands in order to meet their local needs and pan-West Midlands need.
• Unfortunately on its information system Birmingham LASSD was unable to disaggregate people it had placed in the independent sector on the basis of their diagnosis1. Recording mechanisms within commissioning organisations should allow for client groups to be separated for various forms of monitoring. Commissioning organisations should review their ability to disaggregate data they collect.
Information sharing between commissioners • During this project many commissioners have expressed a concern about the variable quality amongst independent sector providers. Many also informed us that they did not have sufficient information about a service upon which to base a placement decision. Opportunities for sharing information about services between commissioners should be considered with the NIMHE RDC.
Commissioning practice and support • Commissioners should be supported to develop a toolkit for commissioning independent sector placements. The NIMHE RDC is commissioning such support, however to be effective it will require the active participation of commissioners in the West Midlands.
1 The primary exclusion criteria for the study were people who had an organic illness and were funded solely by social services in care home placements. Those who participated in the design of the data collection instrument felt that to include this group would have increased the size of the project beyond their ability to provide the data. The numbers were felt to be too great for the amount of “new” information that would be gained. All those with a functional illness over 65 have been included for all other areas. Birmingham LASSD was unable to differentiate between older people with a functional illness and those with an organic illness, consequently these cases have not been included in the study. ‘A census day audit of mental health independent sector placements in the West Midlands’ 16 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Practice development • This project has identified a wide range of client groups, some with particularly complex needs. NIMHE and NHS provider Trusts should consider how Care Co- ordinators of complex cases placed out of area can share knowledge and expertise to develop their practice. Any such network or forum should involve the participation of, or feedback to, placement commissioners.
Further audit work • The data collated in this study for CAMHS has been built upon a project designed for adults and consequently does not capture some data specific to this client group. A further study of the specific needs in the CAMHS area should be considered by commissioners, NIMHE and SHAs.
• A further census could be undertaken in 18-24 months to establish how the situation has changed following any initiatives that are undertaken to address issues highlighted in this project. Alternatively, the development of a database similar to the one being supplied by Manchester University could lead to a system similar to that operated at Durham University for the annual mapping review. Each commissioner would have a tool that could support them in tracking of out of sector placements. Such a system could allow for pan-SHA and pan-region snapshots which could track changes over time against system wide interventions by commissioners, NIMHE and the SHAs. This could be hosted on the NIMHE website or a SHA website and would prevent the need to repeat the census day exercise in the future.
• A great deal of comparative data can be used alongside the data collected in this project. Commissioners, NHS providers and NIMHE should consider what would be useful to the service system and may wish to commission further analysis.
• Commissioners within the Birmingham and Black Country SHA area use more placements in the independent sector than the other two SHA areas together and requires further investigation to determine why this is the case.
Other issues • Methods of involving users and carers of out of sector placements within the process of monitoring and managing the service system should be considered.
‘A census day audit of mental health independent sector placements in the West Midlands’ 17 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Appendix 1 – Response rate and numbers of cases across the West Midlands
Each PCT and LASSD was asked to return details on all cases of individuals placed in mental health facilities in the private or voluntary sectors. This includes adults, older adults and children.
PCTs (n = 30) and LASSDs (n = 14) in the West Midlands all returned information in respect of adults and CAMHS (100% response rate). In respect of older people, no returns were obtained from the Birmingham LASSD as they were unable to distinguish between functional and organic illnesses leaving a response rate of 97.8%). Data for forensic clients was provided by the West Midlands Specialised Commissioning Services Agency.
A total of 2,173 cases were returned in the West Midlands as a whole: 1,376 (63.3%) were adults; 628 (28.9%) were older people; and 110 (5.1%) were children or adolescents. In 59 cases (2.7%) the age group was not recorded.
Numbers of cases returned in the West Midlands are shown in tables 11 – 13 below, grouped according to Strategic Health Authority.
‘A census day audit of mental health independent sector placements in the West Midlands’ 18 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Appendix 2 – Adjusted registered (April 2003) & Census 2001 PCT, Provider Trust and SHA populations – all ages
Primary Care Trusts Adj. reg. Census pop 2001 pop Dudley Beacon and Castle PCT 104,327 111,959 Dudley South PCT 194,901 193,196 Eastern Birmingham PCT 227,511 208,570 Heart of Birmingham Teaching PCT 280,063 250,735 North Birmingham PCT 167,354 160,279 Oldbury and Smethwick PCT 102,198 87,936 Rowley Regis and Tipton PCT 81,133 91,126 Solihull PCT 198,848 199,517 South Birmingham PCT 336,711 357,503 Walsall Teaching PCT 245,978 253,499 Wednesbury and West Bromwich PCT 113,926 103,842 Wolverhampton City PCT 241,279 236,582 Coventry Teaching PCT 319,345 300,848 Herefordshire PCT 173,600 174,871 North Warwickshire PCT 174,598 180,992 Redditch and Bromsgrove PCT 157,198 162,361 Rugby PCT 83,719 87,453 South Warwickshire PCT 243,796 237,415 South Worcestershire PCT 271,527 278,482 Wyre Forest PCT 106,970 101,264 Burntwood, Lichfield and Tamworth PCT 146,013 152,153 Cannock Chase PCT 124,360 128,274 East Staffordshire PCT 120,292 112,727 Newcastle-under-Lyme PCT 100,513 101,995 North Stoke PCT 123,806 118,621 Shropshire County PCT 275,153 283,173 South Stoke PCT 132,515 129,690 South Western Staffordshire PCT 178,934 197,071 Staffordshire Moorlands PCT 102,921 106,849 Telford and Wrekin PCT 159,749 158,325
There are considerable variations between the adjusted registered populations served by each PCT (81,133 – 336,711) or Census 2001 populations (i.e. PCT range: 91,126 – 357,503). The data presented in this report has not been weighted to take account of this variance. Consequently, these tables are provided in order to assist interpretation by the reader.
‘A census day audit of mental health independent sector placements in the West Midlands’ 19 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Secondary Mental Health Provider Trusts Adj. reg. Census pop 2001 pop Birmingham and Solihull MH NHS Trust 1,210,487 1,176,604 Coventry Teaching PCT 319,345 300,848 Dudley Beacon and Castle PCT 299,228 305,155 Herefordshire PCT 173,600 174,871 North Staffordshire Combined Healthcare NHS Trust 459,755 457,155 North Warwickshire PCT 258,317 268,445 Sandwell MH NHS and Social Care Trust 297,257 282,904 Shropshire County PCT 434,902 441,498 South Staffordshire Healthcare NHS Trust 569,599 590,225 South Warwickshire PCT 243,796 237,415 Walsall Teaching PCT 245,978 253,499 Worcestershire Mental Health Partnership NHS Trust 535,695 542107 Wolverhampton City PCT 241,279 236582
Strategic Health Authorities Adj. reg. Census pop 2001 pop Birmingham and the Black Country SHA 2,294,229 2,254,744 West Midlands South SHA 1,530,753 1,523,686 Shropshire and Staffordshire SHA 1,464,257 1,488,878
(Source: Adjusted Registered Population Source: Department of Health, 2003b; Census 2001 Population Source: National PCT Database)
‘A census day audit of mental health independent sector placements in the West Midlands’ 20 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Appendix 3 – West Midlands overview
This section of the report provides a summary overview of the West Midlands. Further detail is provided by Strategic Health Authority area.
Cases
Strategic Health Authority Age Grouping Total CAMHS Adults Older (%) Peopl e Birmingham and Black Country 61 778 275 1114 (52.7) West Midlands South 10 344 193 547 (25.9) Shropshire & Staffs 39 254 160 453 (21.4) Missing information 59 (2.7) Total 110 1376 628 2173 (100.0)
Table 1. Total placements across the West Midlands
Over half of the 2,173 people placed out of sector on the day of the census where from within the Birmingham and Black Country SHA area.
Gender Gender Frequency Percent
Male 1180 54.3 Female 982 45.2 Total 2162 99.5 Missing information 11 0.5 Total 2173
‘A census day audit of mental health independent sector placements in the West Midlands’ 21 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 2. Gender of people placed out of sector
Ethnicity
Ethnicity Frequency Percent
White British 1674 77.0 Caribbean 96 4.4 Indian 47 2.2 Irish 23 1.1 Any other White background 18 0.8 Pakistani 14 0.6 White & Black Caribbean 10 0.5 Any other Mixed background 8 0.4 Any other 7 0.3 Any other Asian background 6 0.3 African 6 0.3 Any other Black background 4 0.2 White & Black African 1 0.0 White & Asian 1 0.0 Bangladeshi 1 0.0 Total 1916 88.2 Missing 257 11.8 Total 2173 100.0
‘A census day audit of mental health independent sector placements in the West Midlands’ 22 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 3. Ethnicity of people placed out of sector in the West Midlands
While these figures highlight the range of ethic groups across the West Midlands they do not account for local variations within populations and the many factors that affect prevalence and rates of diagnosis.
Psychiatric diagnosis
Principal psychiatric diagnosis Frequenc Percent y Schizophrenia 580 26.7 Non-specific mental illness 556 25.6 Dementia 273 12.6 Bi-polar disorder/affective psychosis 97 4.5 Depression 92 4.2 Early onset dementia 81 3.7 Personality disorder 81 3.7 Autism/Asperger's syndrome 68 3.1 Other 54 2.5 Korsakoff's Syndrome 51 2.3 Acquired brain injury 46 2.1 Schizo-affective disorder 40 1.8 Other psychotic disorder 38 1.7 Eating disorder 32 1.5 Other organic condition 30 1.4 Anxiety disorder 24 1.1 Huntington's Chorea 23 1.1 Other neurotic disorder 6 0.3 Pick's disease 1 0.0 Total 2173 100.0
Table 4. Principal psychiatric diagnosis of people placed out of sector in the West Midlands
There are considerable numbers of people with diagnoses that are uncommon within the patch of a single commissioner. However, when the data is aggregated groups are highlighted where the development of services could probably better meet the needs of individuals. There are likely to be many people who are placed in facilities that do not cater specifically for their specialist needs e.g. Korsakoff’s Syndrome and Huntington’s Chorea. Furthermore, because of the limited umber of placements from each commissioning authority for some of these conditions it is unlikely that block contracting arrangements exist for facilities which specialize in some of these areas e.g. acquired brain injury, early onset dementia and eating disorders. Disappointingly the specific diagnosis of just over one quarter of all people was not known. ‘A census day audit of mental health independent sector placements in the West Midlands’ 23 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Mental Health Act Status
Mental Health Act status Frequency Percent
Informal 911 41.9 Don't know 748 34.4 Section 117 245 11.3 Section 3 132 6.1 Section 37/41 47 2.2 Section 37 27 1.2 Section 7 (Guardianship) 17 0.8 Section 2 13 0.6 Children Act Provision 11 0.5 Section 47/49 8 0.4 Section 38 7 0.3 Section 25 6 0.3 Other 1 0.0 Total 2173 100.0
Table 5. Mental Health Act status of people placed out of sector in the West Midlands
The Mental Health Act status of over one third of the people placed out of sector was not known. Unsurprisingly the largest grouping whose legal status was known was people who were informal.
‘A census day audit of mental health independent sector placements in the West Midlands’ 24 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Provider organisations
A total of 440 different organisations were used by West Midlands commissioners on the day of the census. Twenty-five organisations were providing placements for 20 people or more and accounted for 41.2% of placements. There were 240 organisations were only one person was placed by West Midlands commissioners, these accounted for 11.2% of all of the placements.
Organisation Frequency Percent MIND 88 4.0 Highfield Care Homes Ltd 86 4.0 BUPA Care Homes Ltd 68 3.1 Focus Housing Association 54 2.5 St Andrews Hospital 50 2.3 Partnerships In Care Ltd 48 2.2 Rethink 44 2.0 Ashleigh Healthcare Ltd 32 1.5 Extra Care Charitable Trust 32 1.5 Shaw Healthcare Homes Ltd 32 1.5 John Munroe Independent Hospital 28 1.3 Churchill Court Healthcare Ltd 25 1.2 Ralton Care Homes Ltd 25 1.2 Caldmore Housing Association Ltd 25 1.2 Richmond Fellowship 25 1.2 Holmer Nursing Home 24 1.1 Craegmoor Healthcare Ltd 23 1.1 The Priory Group 23 1.1 Orchard House NH 23 1.1 Wilson Care Resource Ltd 23 1.1 Minehome Ltd 22 1.0 Ashborne Homes ltd 22 1.0 Radnor House 22 1.0 Newllyn Court Ltd 21 1.0 Heantun Care Housing Association Ltd 20 0.9
‘A census day audit of mental health independent sector placements in the West Midlands’ 25 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Table 6. Most used organisations by West Midlands commissioners on the day of the census
The market used by the West Midlands commissioners is clearly dominated by the private sector.
Sector Frequency Percent
Private 1778 81.8 Voluntary 370 17.0 Don't know 25 1.2 Total 2173 100.0
Table 7. Area of independent sector used by the West Midlands commissioners
Suitability of placement
Is the placement appropriate? Frequency Percent
Yes 1475 67.9 No 90 4.1 Don't know 608 28.0 Total 2173 100.0
Table 8. Suitability of placement to need at the time of census
Over two-thirds of the cases were felt by commissioners to be appropriate, however in a over a quarter of cases the suitability of the placement was not known.
Funding arrangements
Although an extremely high response rate was obtained across the West Midlands in this project some data is missing (i.e. older people from Birmingham LASSD and a small number of cases were no financial data was provided). Consequently, the figures that are detailed here are less than the true costs that was being spent on the census day. Placement funder Frequency Percent
Social services 979 45.1 Joint health & social services 575 26.5 Health 562 25.9 3 Way, PCT, SSD & Education 25 1.2 PCT & Education 7 0.3 Other 5 0.2 Total 2153 99.1 Missing 20 0.9 Total 2173 100.0 ‘A census day audit of mental health independent sector placements in the West Midlands’ 26 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 9. Funder of placement
Cost of placements
Cost per week (£) Cases Maximum Sum (£) Health 528 15,745 989,432 Social services 952 4,670 374,794 Pooled/joint 521 4890 397,543 Other 31 4,944 45,929 Missing 121 Total 2153 1,807,698
Table 10. Cost of placements during the census week Note: ‘Other’ placements included some funded in joint arrangements with Education authorities.
Based on the census day the total annual cost of independent sector placement to the NHS and LASSDs in the West Midlands is at least £94 million.
Placements commissioned by client’s PCT within each Strategic Health Authority area
A breakdown of placements by PCT and age group is provided below for each of the three Strategic Health Authority areas.
Patient's PCT Age grouping Total CAMHS Adults Older people Dudley Beacon & Castle 0 65 17 82 Dudley South 4 14 1 19 Eastern Birmingham 8 18 2 28 Heart Of Birmingham 5 39 1 45 North Birmingham 6 10 3 19 Oldbury & Smethwick 0 23 6 29 Rowley Regis & Tipton 0 14 5 19 Solihull 10 24 13 47 South Birmingham 9 38 2 49 Walsall 13 123 174 310 Wednesbury & West Bromwich 1 34 7 42 Wolverhampton City 5 79 44 128 Birmingham PCTs (joint) 0 297 0 297 Total 61 778 275 1114 (5.5%) (69.8%) (24.7%)
Table 11. Patient's PCT and Age Grouping: Birmingham and the Black Country SHA
Note: Information could not be obtained from the Birmingham Social Services in relation to older people. ‘A census day audit of mental health independent sector placements in the West Midlands’ 27 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
A lower proportion of placements involve people aged 65 years and over than in the other two Strategic Health Authority areas, probably reflecting the failure to obtain information on older people in Birmingham.
However, numerically far more placements over all age groups were returned involving people placed by PCTs in the Birmingham and Black Country SHA, compared with the other two strategic health authority areas.
Patient’s PCT Age grouping Total CAMHS Adults Older people Coventry 3 85 8 96 Herefordshire 3 74 29 106 North Warwickshire 2 33 65 100 Redditch & Bromsgrove 1 13 8 22 Rugby 0 35 25 60 South Warwickshire 0 42 41 83 South Worcestershire 1 42 13 56 Wyre Forest 0 20 4 24 Total 10 344 193 547 (1.8%) (62.9%) (35.3%)
Table 12. Patient’s PCT and Age Grouping: West Midlands South SHA
Age grouping Total Patient's PCT CAMHS Adults Older people Burntwood, Litchfield & 4 16 15 35 Tamworth Cannock Chase 3 14 5 22 East Staffordshire 2 14 2 18 Newcastle under Lyme 1 4 0 5 North Stoke 2 14 3 19 Shropshire County 23 30 5 58 South Stoke 1 6 0 7 South Western Staffordshire 1 21 18 40 Staffordshire Moorlands 1 8 6 15 Telford & Wrekin 1 42 7 50 Staffs PCTs (joint) 0 51 81 132 Stoke PCTs (joint) 0 34 18 52 Total 39 254 160 453 (8.6%) (56.1%) (35.3%)
Table 13. Patient's PCT and Age Grouping: Shropshire and Staffordshire SHA Further analysis is provided by Strategic Health Authority.
‘A census day audit of mental health independent sector placements in the West Midlands’ 28 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Appendix 4 – Birmingham and the Black Country Strategic Health Authority
Adults up to 64 years of age
Gender, age and ethnicity of people placed
Demographic details are shown in table 14.
Adults (<65) in Summary statistics private/voluntary sector
Gender Number (%) male 489 (62.9) Number (%) female 286 (36.8) Missing information 3 (0.4)
Age Mean age in years, range of 46 (18-64) ages
Ethnicity (number %) 485 (62.3) White British 10 (1.3) Irish 10 (1.3) Other white background 6 (0.8) White and Black Caribbean 5 (0.6) Any other mixed background 33 (4.2) Indian 12 (1.5) Pakistani 6 (0.8) Any other Asian background 72 (9.3) Caribbean 5 (0.6) African 4 (0.5) Any other black background 5 (0.6) Any other 125 (16.1) Missing information 778 (100) TOTAL
Table 14. Gender, age and ethnicity of adults (under 65) placed in private/voluntary facilities: Birmingham and the Black Country SHA
‘A census day audit of mental health independent sector placements in the West Midlands’ 29 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Markedly more men than women are placed in the private or voluntary sectors. Many women may be placed in facilities catering for larger numbers of men. There was no significant difference between men and women in terms of age.
The population placed is ethnically diverse. This raises issues of the cultural competence of services commissioned
Principal psychiatric diagnoses Categories of ‘diagnosis’ were selected to reflect some of the more unusual syndromes, where lack of local capability might lead to placement in the independent sector.
Known diagnoses are shown in table 15.
Principal psychiatric diagnosis Number Percent
Huntington's Chorea 6 0.8 Korsakoff's Syndrome 16 2.1 Early onset dementia 23 3.0 Acquired brain injury 11 1.4 Other organic condition 3 0.4 Schizophrenia 221 28.4 Schizo-affective disorder 16 2.1 Bi-polar disorder/affective psychosis 33 4.2 Other psychotic disorder 12 1.5 Depression 18 2.3 Anxiety disorder 4 0.5 Other neurotic disorder 1 0.1 Eating disorder 3 0.4 Personality disorder 38 4.9 Autism/Asperger's syndrome 5 0.6 Non-specific mental illness 364 46.8 Dementia 1 0.1 Other 3 0.4 Total 778 100.0
Table 15. Principal diagnoses of adults (under 65) placed in private/voluntary facilities: Birmingham and the Black Country SHA
Just over a third half of adults placed have known psychotic illnesses, and almost half have no known specific diagnosis. The remainder include people with diagnoses that may be harder to provide for within mainstream services.
Additional problems of alcohol dependence were recorded in 67 cases (8.6%) and drug dependence in 18 cases (2.3%).
‘A census day audit of mental health independent sector placements in the West Midlands’ 30 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Additional problems of learning disability were recorded in 47 cases (6.0%), and deafness in 8 cases (1.0%).
Legal status of individuals placed
Table 16 shows the legal status of adults placed in private or voluntary facilities.
Mental Health Act status Number Percent
Informal 158 20.3 Section 3 42 5.4 Section 7 (Guardianship) 10 1.3 Section 25 3 0.4 Section 37 5 0.6 Section 37/41 20 2.6 Section 38 6 0.8 Section 117 104 13.4 Section 47/49 6 0.8 Other 1 0.1 Don't know 423 54.4 Total 778 100.0
Table 16. Mental Health Act status of adults placed in private or voluntary facilities: Birmingham and the Black Country SHA
The Mental Health Act status of the majority of patients was ‘not known’ by the person completing the census returns. Most of the remainder are placed as informal patients, or as part of arrangements following detention under Section 3. A further group are subject to formal detention under Part 2 of the Act, and some are placed under Part 3 (forensic provisions).
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the individual placed. In 356 cases (45.8%) commissioners indicated that the placement was appropriate, in 36 cases (4.6%) the placement was not appropriate, whilst in 386 cases (49.6%) the individual completing the form did not know whether the placement was appropriate or not.
The placements
Table 17 indicates the sector of placements used in Birmingham and the Black Country. ‘A census day audit of mental health independent sector placements in the West Midlands’ 31 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Sector of provision Number Percent
Private 584 75.1 Voluntary 183 23.5 Don't know 11 1.4 Total 778 100.0
Table 17. Sector of provision for adults under 65: Birmingham and the Black Country SHA
It is clear that the private market dominates provision outside of the statutory agencies.
Types of placement are shown in table 18.
Type of placement Number Percent
Acute in-patient ward 7 0.9 Psychiatric Intensive Care Unit 1 0.1 Low secure/high dependency unit 4 0.5 Medium secure unit 49 6.3 Rehabilitation unit 99 12.7 Continuing care service 596 76.6 Psychotherapy service (in-patient) 5 0.6 Specialist eating disorder facility 1 0.1 Women only Unit 3 0.4 Other service 6 0.8 Missing information 7 0.9 Total 778 100.0
Table 18. Types of adult placements in private or voluntary sector: Birmingham and the Black Country SHA.
Longer term or non-specialist units predominate in overall provision.
Types of Healthcare Commission and Commission for Social Care Inspection registration are shown in table 19.
Type of registration Number Percent
‘A census day audit of mental health independent sector placements in the West Midlands’ 32 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Independent hospital 79 10.2 Care home with nursing 294 37.8 Care home 394 50.6 Total 767 98.6 Missing information 11 1.4 Total 778 100.0
Table 19. Type of registration: Birmingham and the Black Country SHA adult placements
Independent hospitals, care homes with nursing and care homes were all provided by the private and the voluntary sectors, although the voluntary sector provision was more likely to be described as ‘care homes’.
Placements were funded in a variety of ways. Table 20 shows the funding sources.
Sources of funding Number Percent
Health 153 19.7 Social services 462 59.4 Joint health & social services 156 20.1 Other 1 0.1 Missing information 6 0.8 Total 778 100.0
Table 20. Placement funding source: adults placed in voluntary or private sector Birmingham and the Black Country SHA
Social Services are funding the largest number of placements, more than twice the number funded by PCTs. Social Services funded placements were more likely to be registered as ‘care homes’, PCT funding was more likely to underpin ‘independent hospital’ registered placements, and joint funding predominated placements registered as ‘care homes with nursing’.
Costs of placements
‘A census day audit of mental health independent sector placements in the West Midlands’ 33 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Average costs are shown in table 21.
Average weekly Maximum weekly Type of funding cost per placement cost placement (£) (£) Health service only 1905 9317
LA Social Services 419 1912 only
Joint 532 2163
Average added cost 881 5712 of ‘specialing’ (9 cases)
All placements 741 9317
Table 21. Average costs of adult placements commissioned in the private and voluntary sectors: Birmingham and the Black Country SHA
Note: Cost information missing in 31 cases (not included)
Total weekly costs of all placements in the census week: £553,369
Total weekly cost to NHS funders in the census week: £320,155
Total weekly cost to LASSD funders in the census week: £244,560
Additional cost of ‘specialing’ in the census week £ 7,927
If the census week is assumed to be typical, current TOTAL costs approximate £29.2 million per annum for adults under 65 years of age placed by PCTs and LASSDs in the Birmingham and the Black Country strategic health authority area. This includes the costs of ‘special commissioning’ (forensic services).
Social Services funds a greater number of placements but PCT funding predominates in the high-cost placements leading to higher overall costs to the NHS.
Linkage to CPA mechanisms
‘A census day audit of mental health independent sector placements in the West Midlands’ 34 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Commissioners completing the census forms were asked whether individuals placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 22.
Named Care co- Percent District of Percent professional ordinator origin (number) consultant (number) Yes 398 51.2 329 42.3 No 43 5.5 117 15.0 Don't know 337 43.3 332 42.7 Total 778 100.0 778 100
Table 22. Individuals with Care Co-ordinator and District of origin consultant at point of census: Birmingham and the Black Country SHA private and voluntary placements
When these figures are combined, a total of 425 out of 778 (54.6%) individuals placed are known to have either a named care co-ordinator, or a named District of origin consultant, or both. However, a minority do not have this formal linkage. The study was not designed to establish the robustness or otherwise of the formal links.
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each individual placement during the 12 month period preceding the census. Table 23 indicates the number who affirmed that they had received this feedback.
It must be acknowledged that there were inconsistencies between areas in the way in which the census forms were completed, and many were not completed directly by commissioners but by others in the organization. The information contained in table 13 is therefore broadly indicative only of the use of various channels of feedback.
Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received
‘A census day audit of mental health independent sector placements in the West Midlands’ 35 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Number (%)
Written report from 259 (33.3) 151 (19.4) 368 (47.3) care co-ordinator Verbal report from 135 (17.4) 219 (28.1) 424 (54.5) care co-ordinator Written report from 173 (22.2) 197 (25.3) 408 (52.4) service provider Verbal report from 151 (19.4) 188 (24.2) 439 (56.4) service provider Visit to placement by 86 (11.1) 221 (28.4) 471 (60.5) commissioner Care review attended 97 (12.5) 224 (28.8) 457 (58.7) by commissioner Written carer or 42 (5.4) 313 (40.2) 423 (54.4) relative contact Verbal carer or 83 (10.7) 240 (30.8) 455 (58.5) relative contact Written patient 43 (5.5) 317 (40.7) 418 (53.7) contact Verbal patient 138 (17.7) 186 (23.9) 454 (58.4) contact 149 (19.2) 207 (26.6) 422 (54.2) Healthcare commission reports 6 (0.8) 351 (45.1) 421 (54.1) Mental Health Act Commission Report
Table 23. Feedback to commissioners: Birmingham and the Black Country SHA private and voluntary placements (adults <65)
Reasons for placement
Reasons for placement in private Number Percent or voluntary sector Lack of local capacity 163 21.0 Lack of local capability 68 8.7 Most appropriate to needs 19 2.4 Family Reasons 3 0.4 Resettlement project 5 0.6 Other 76 9.8 Don't know 444 57.1 Total 778 100.0
Table 24. Reasons for placements of adults under 65 years of age in the private and voluntary sectors: Birmingham and the Black Country SHA
‘A census day audit of mental health independent sector placements in the West Midlands’ 36 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) The largest single group of reasons are ‘not known’, but issues of capacity and capability also feature prominently in the reasons for placement.
Distance from district of origin
As the research team did not have access to home addresses of individuals placed, distances were calculated from the post-code of the PCT or Local Authority funding the placement, and from the post-code of the placement itself. This gives an approximate indication of distances involved, although in county and rural areas the margin of error in approximating ‘distance from home’ will be greater.
Of all adult placements made by organizations within the Birmingham and the Black Country SHA, 565 (72.6%) were identified as being within the geographical catchment area of the funding PCT or LASSD; 201 (25.8%) were outside of the funder’s normal catchment area.
Average distance to placement: 14.4 miles (Range 0.2 – 206 miles)
Average distance to placements outside of PCT or LASSD catchment 45.0 miles (Range 2.5 -206 miles)
Table 25 shows the distance from area of origin according to the placement sector.
Sector Total Distance from base in bands Private Voluntary
0-20 miles Number 506 163 669 % within 87.1% 89.1% 87.6% Sector 21-50 miles Number 13 1 14 % within 2.2% .5% 1.8% Sector over 50 miles Number 62 19 81 % within 10.7% 10.4% 10.6% Sector Total Number 581 183 764 % within 100.0% 100.0% 100.0 Sector %
Table 25. Distance to placement in bands by placement sector: Birmingham and the Black Country SHA (adults up to 65 years)
A substantial number of all adult placements are within 20 miles of the funding PCT or LASSD. The remainder, most of which are private sector placements, are further afield.
‘A census day audit of mental health independent sector placements in the West Midlands’ 37 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Around one in ten of both private and voluntary sector placements are over 50 miles from the funding authority base.
Providers used by Birmingham and the Black Country commissioners
A total of 132 establishments were used as placements for adults under 65 years of age, on the date of the census.
Of these, 66 had only one person placed with them funded by the Birmingham and the Black Country Commissioners. Twenty-four providers had 10 or more people placed with them, funded by Birmingham and the Black Country PCTs or LASSDs on the census date. Table 26 shows the most commonly-used providers.
Provider organisation Number (%) of people placed at census date
MIND 77 (9.9) Focus Housing Association 48 (6.2) Highfield Care Homes Ltd 46 (5.9) Ashleigh Healthcare Ltd 26 (3.3) Partnerships in Care Ltd 24 (3.1) Caldmore Housing Association Ltd 24 (3.1) Wilson Care Resources Ltd 23 (3.0) Radnor House 22 (2.8) Ashbourne Homes Ltd 20 (2.6) Churchill Court Healthcare Ltd 18 (2.3) St.Andrew’s Hospital 16 (2.1) Heritage Healthcare Ltd 16 (2.1) Wordsley Hall 16 (2.1) Exceller Healthcare Services Ltd 15 (1.9) Shaw Healthcare Homes Ltd 13 (1.7) BUPA Care Homes Ltd 12 (1.5) NHP Healthcare Partnerships 12 (1.5) Servol Community Trust 12 (1.5) Orchard House NH 11 (1.4) Rethink 11 (1.4) The Firs NH 11 (1.4) NSF 11 (1.4) St.Peter’s Hall 10 (1.3) Stoneham HA Ltd 10 (1.3)
Table 26: Most commonly used providers for adults: Birmingham and the Black Country SHA
65% of all census day placements were provided by these 24 organisations.
‘A census day audit of mental health independent sector placements in the West Midlands’ 38 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 27 shows the numbers placed broken down according to the provider trusts responsible for normal statutory services in the Birmingham and the Black Country SHA.
Usual statutory Mental Health Number (%) of adults placed Provider Trust in private or voluntary facilities on census date
Birmingham and Solihull Mental Health 426 (54.8) NHS Trust Dudley, Beacon and Castle PCT 79 (10.2)
Sandwell Mental Health NHS and 71 (9.1) Social Care Trust Walsall Teaching PCT 123 (15.8)
Wolverhampton City PCT 79 (10.2)
Table 27. Numbers placed in the private or voluntary sector, and usual statutory provider
Birmingham and Solihull Mental Health NHS Trust is the usual NHS provider for the greatest number of adults placed in the private or voluntary sectors.
Older people aged 65 years and over
Gender, age and ethnicity of older people placed
‘A census day audit of mental health independent sector placements in the West Midlands’ 39 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Demographic details are shown in table 28.
Older people in Summary statistics private/voluntary sector
Gender Number (%) male 110 (40.0) Number (%) female 165 (60.0)
Age Mean age in years, range of 77.3 (63-99) ages
Ethnicity (number %) 255 (92.7) White British 3 (1.1) Any other white background 3 (1.1) Indian 9 (3.3) Caribbean 5 (1.8) Missing information
Table 28. Gender, age and ethnicity of older people (65 and over) placed in private/voluntary facilities: Birmingham and the Black Country SHA
More women than men are placed in the private or voluntary sectors in the older age group. However, this reflects the population proportions.
Principal psychiatric diagnoses
Categories of ‘diagnosis’ were selected to reflect some of the more unusual syndromes, where lack of local capability might lead to placement in the independent sector. Older people with organic illnesses funded solely by Social Services were excluded.
Known diagnoses are shown in table 29.
‘A census day audit of mental health independent sector placements in the West Midlands’ 40 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Principal psychiatric diagnoses Number Percent
Huntington's Chorea 3 1.1 Korsakoff's Syndrome 3 1.1 Early onset dementia 17 6.2 Other organic condition 9 3.3 Schizophrenia 57 20.7 Schizo-affective disorder 5 1.8 Bi-polar disorder/affective psychosis 15 5.5 Other psychotic disorder 10 3.6 Depression 18 6.5 Anxiety disorder 4 1.5 Eating disorder 1 0.4 Personality disorder 1 0.4 Non-specific Mental illness 16 5.8 Dementia 114 41.5 Other 2 0.7 Total 275 100.0
Table 29. Principal diagnoses of older people (65 years and over) placed in private/voluntary facilities: Birmingham and the Black Country SHA
Around a third of older people placed have known psychotic illnesses, and a further two- fifths have dementia.
Additional problems of alcohol dependence were recorded in 10 cases only and drug dependence in no cases.
Additional problems of learning disability were recorded in 5 cases, and deafness in 19 cases. However, in a proportion of cases, these additional factors were recorded as ‘not known’.
Legal status of older individuals placed
Table 30 shows the legal status of older people placed in private or voluntary facilities.
Mental Health Act status Number Percent
Informal 178 64.7 Section 2 1 0.4 Section 3 2 0.7 Section 7 (Guardianship) 1 0.4 Section 37/41 2 0.7 Section 117 21 7.6 Section 47/49 1 0.4 Don't know 69 25.1 Total 275 100.0
‘A census day audit of mental health independent sector placements in the West Midlands’ 41 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 30. Mental Health Act status of older people placed in private or voluntary facilities: Birmingham and the Black Country SHA
Most individuals are placed as informal patients, or as part of Section 117 arrangements following detention under Section 3. There is a marked proportion where legal status was not known.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the older person placed. In 239 cases (86.9%) commissioners indicated that the placement was appropriate, in eight cases the placement was not appropriate, whilst in 28 cases (10.2%) the commissioner completing the form did not know whether the placement was appropriate or not.
The placements
Table 31 indicates the sector of placements used for older people in Birmingham and the Black Country.
Placement sector Number Percent
Private 246 89.5 Voluntary 18 6.5 Don't know 11 4.0 Total 275 100.0
Table 31. Sector of provision for older people aged 65 and over: Birmingham and the Black Country SHA
The dominance of private over voluntary provision is as marked as in the adult sector.
Types of placement are shown in table 32.
Type of unit Number Percent
Acute in-patient ward 1 0.4 Low secure/high dependency unit 3 1.1 Medium secure unit 2 0.7 Rehabilitation unit 5 1.8 Continuing care service 263 95.6 Other service 1 0.4 Total 275 100.0 ‘A census day audit of mental health independent sector placements in the West Midlands’ 42 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 32. Types of placements for older people in private or voluntary sector: Birmingham and the Black Country SHA.
Continuing care units predominate in overall provision.
Types of registration with the Healthcare Commission and Commission for Social Care Inspection are shown in table 33.
Type of registration Number Percent
Independent hospital 4 1.5 Care home with nursing 205 74.5 Care home 55 20.0 Missing information 11 4.0 Total 275 100.0
Table 33. Type of registration: Birmingham and the Black Country SHA placements for older people
Within the private sector the majority of placements were in premises designated as ‘care homes with nursing’ whilst in the voluntary sector placements were both ‘care homes’ and ‘care homes with nursing’.
Placements were funded in a variety of ways. Table 34 shows the funding sources.
Funder of placement Number Percent
Health 68 24.7 Social Services 96 34.9 Joint Health & Social Services 110 40.0 Other 1 0.4 Total 275 100.0
Table 34. Placement funding source: older people placed in voluntary or private sector Birmingham and the Black Country SHA
Social Services authorities are the sole funder for a smaller proportion of placements than is the case in the adult sector. Joint funding arrangements are markedly more common for older people.
‘A census day audit of mental health independent sector placements in the West Midlands’ 43 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Costs of placements
Average costs are shown in table 35.
Average weekly Maximum weekly Type of funding cost per placement cost placement (£) (£)
Health service only 678 2947
LA Social Services 351 917 only
Joint 416 806
All placements 461 2947
Table 35. Average costs of placements for older people commissioned in the private and voluntary sectors: Birmingham and the Black Country SHA
Note: Cost information missing in 15 cases
Total weekly costs of all placements in the census week: £119,949
Total weekly cost to NHS funders in the census week: £54,293
Total weekly cost to LASSD funders in the census week: £66,391
If the census week is assumed to be typical, current TOTAL costs approximate £6.2 million per annum for older people aged 65 years of age and over, placed by PCTs and LASSDs in the Birmingham and the Black Country strategic health authority area.
For older people Social Services fund more placements numerically, and also bear the highest overall cost burden.
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether older people placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 36.
‘A census day audit of mental health independent sector placements in the West Midlands’ 44 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Named Care co- Percent District of Percent professional ordinator origin (Number) consultant (Number) Yes 118 42.9 102 37.1 No 134 48.7 132 48.0 Don't 23 8.4 41 14.9 know Total 275 100 275 100
Table 36. Older people with Care Co-ordinator and District of origin consultant at point of census: Birmingham and the Black Country SHA private and voluntary placements
When these figures are combined, a total of 141 (51.3%) out of 275 individuals placed have either a named care co-ordinator, or a named District of origin consultant, or both. However, a sizable minority (93, 33.8%) have neither a care co-ordinator nor a district- of-origin consultant.
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each older person placed, during the 12 month period preceding the census date. Table 37 indicates the number who affirmed that they had received this feedback.
‘A census day audit of mental health independent sector placements in the West Midlands’ 45 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 50 (18.2) 162 (58.9) 63 (22.9) care co-ordinator Verbal report from 21 (7.6) 189 (68.7) 65 (23.6) care co-ordinator Written report from 11 (4.0) 183 (66.5) 81 (29.5) service provider Verbal report from 28 (10.2) 169 (61.5) 78 (28.4) service provider Visit to placement by 15 (5.5) 183 (66.5) 77 (28.0) commissioner Care review attended 13 (4.7) 187 (68.0) 75 (27.3) by commissioner Written carer or 10 (3.6) 181 (65.8) 84 (30.5) relative contact Verbal carer or 21 (7.6) 171 (62.2) 83 (30.2) relative contact Written patient 5 (1.8) 188 (68.4) 82 (29.8) contact Verbal patient 30 (10.9) 167 (60.7) 78 (28.4) contact 150 (54.5) 60 (21.8) 65 (23.6) Healthcare commission reports 1 (0.4) 210 (76.4) 64 (23.3) Mental Health Act Commission Report
Table 37. Feedback to commissioners: Birmingham and the Black Country SHA private and voluntary placements of older people
In a large number of cases, those completing the census forms did not have access to information about this type of feedback, explaining the substantial number of ‘not known’ responses.
‘A census day audit of mental health independent sector placements in the West Midlands’ 46 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Reasons for placement
Reasons given for placements are shown in table 38.
Reasons for placement Number Percent
Lack of local capacity 120 43.6 Lack of local capability 21 7.6 Most Appropriate to Needs 11 4.0 Family Reasons 13 4.7 Resettlement Project 21 7.6 Other 46 16.7 Don't know 43 15.6 Total 275 100.0
Table 38. Reasons for placements of older people aged 65 years and over in the private and voluntary sectors: Birmingham and the Black Country SHA
Lack of local capacity is a major reason for placement. Many placements are likely to be long-standing, and the original reasons for placement may be unavailable.
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as for adults. Of all placements of older people made by organizations within the Birmingham and the Black Country SHA, 164 (59.6%) were identified as being within the geographical catchment area of the funding PCT or LASSD; 96 (34.9%) were outside of the funder’s normal catchment area. This is a slightly lower proportion of older people placed within the normal funder’s catchment area as for adults under 65 years.
Average distance to placement: 7.9 miles (Range 0.5 – 211 miles)
Average distance to placements outside of PCT or LASSD catchment 14.5 miles (Range 1.1 - 211 miles)
Providers used by Birmingham and the Black Country commissioners
A total of 60 establishments were used as placements for older people, on the date of the census.
Of these, 31 had only one person placed with them funded by the Birmingham and the Black Country Commissioners. Eleven providers had 5 or more people placed with
‘A census day audit of mental health independent sector placements in the West Midlands’ 47 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) them, funded by Birmingham and the Black Country PCTs or LASSDs on the census date. Table 39 shows the most commonly-used providers.
Provider organisation Number (%) of people placed at census date
BUPA Care Homes Ltd. 49 (17.8) Highfield Care Homes Ltd. 30 (10.9) Ralton Care Homes Ltd. 23 (8.4) Newllyn Court Ltd. 20 (7.3) Heanton Care Housing Association Ltd. 19 (6.9) Orchard House NH 11 (4.0) The Homestead Care Home Ltd. 8 (2.9) Needwood House NH 6 (2.2) Churchill Court Healthcare Ltd. 6 (2.2) Accord Housing Association 6 (2.2) Harper House 5 (1.8)
Table 39: Most commonly used providers for older people: Birmingham and the Black Country SHA
Five providers dominate, together having just over 50% of placements.
Table 40 shows the numbers placed broken down according to the provider trusts responsible for normal statutory services in the Birmingham and the Black Country SHA.
Usual statutory provider Number Percent
Walsall Teaching PCT 174 63.3 Wolverhampton City PCT 44 16.0 Birmingham and Solihull MH NHS Trust 21 7.6 Dudley Beacon and Castle PCT 18 6.5 Sandwell MH NHS and Social Care Trust 18 6.5 Total 275 100.0
Table 40. Numbers of older people placed on census date, and usual statutory provider
Walsall Teaching PCT is the usual statutory provider for the greatest number of placements of older people made outside of the statutory sector.
‘A census day audit of mental health independent sector placements in the West Midlands’ 48 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Children and adolescents (in CAMHS)
Gender, age and ethnicity of children and adolescents placed
Sixty-one users of child and adolescent mental health services in the voluntary and private sectors (including placements in residential schools for ‘mental health’ reasons) were identified in the census in the Birmingham and the Black Country SHA. Demographic details are shown in table 41.
Children and adolescents in Summary statistics private/voluntary sector
Gender Number male 38 (62.3) Number female 23 (37.7)
Age Mean (years), range 15 (8-18)
Ethnicity (number %) White British 37 (60.7%) Other white background 1 (1.6%) White and black Caribbean 3 (4.9) Caribbean 1 (1.6) Information not provided 19 (31.1)
Table 41. Gender, age and ethnicity of children and adolescents placed in private/voluntary facilities: Birmingham and the Black Country SHA
Most are described as ‘white British’ or the information on ethnicity was not known.
Principal psychiatric diagnoses
Known diagnoses are shown in table 42.
‘A census day audit of mental health independent sector placements in the West Midlands’ 49 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Principal psychiatric diagnosis Number Percent
Schizophrenia 1 1.6 Bi-polar disorder/affective psychosis 1 1.6 Other psychotic disorder 2 3.3 Depression 1 1.6 Other neurotic disorder 2 3.3 Eating disorder 12 19.7 Personality disorder 1 1.6 Autism/Asperger's syndrome 7 11.5 Non-specific Mental illness 16 26.2 Other 18 29.5 Total 61 100.0
Table 42. Principal diagnoses of children and adolescents placed in private/voluntary facilities: Birmingham and the Black Country SHA
In most cases a specific diagnostic category was not assigned.
In four cases a problem of alcohol dependence was identified, and in a further 4 cases a problem of drug dependence. In 13 cases an additional problem of learning disability was recorded.
Legal status of young people placed
Table 43 shows the legal status of the young people placed in private or voluntary facilities.
Legal status Number Percent
Informal 27 44.3 Section 2 3 4.9 Section 3 3 4.9 Section 37 2 3.3 Don't know 17 27.9 Children Act Provision 9 14.8 Total 61 100.0
Table 43. Mental Health Act status of children and adolescents placed in private or voluntary facilities: Birmingham and the Black Country SHA
The largest group (27 young people) are placed without formal legal measures.
‘A census day audit of mental health independent sector placements in the West Midlands’ 50 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the young person placed. In 38 cases the placement was said to be appropriate, in 4 cases it was not appropriate, and in 19 cases the response was ‘don’t know’.
The placements
Table 44 indicates the sector of placements used for young people in Birmingham and the Black Country.
Sector Number Percent
Private 43 70.5 Voluntary 15 24.6 Don't know 3 4.9 Total 61 100.0
Table 44. Sector of provision for children and adolescents: Birmingham and the Black Country SHA
Most young people are placed within the private sector.
Types of placement are shown in table 45.
Type of placement Number Percent
Acute in-patient ward 4 6.6 Psychiatric Intensive Care Unit 1 1.6 Medium secure unit 3 4.9 Rehabilitation unit 9 14.8 Psychotherapy service (in-patient) 1 1.6 Specialist eating disorder facility 10 16.4 Specialist Residential School 15 24.6 CAMHS Residential Unit 17 27.9 Total 60 98.4 Missing 1 1.6 Total 61 100.0
‘A census day audit of mental health independent sector placements in the West Midlands’ 51 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Table 45. Types of placements for young people in private or voluntary sector: Birmingham and the Black Country SHA.
Placements were funded in a variety of ways. Table 46 shows the funding sources.
Funder of placement Number Percent
Health 23 37.7 Joint health & social services 24 39.3 3 Way (PCT, SSD & Education) 13 21.3 Total 60 98.4 Missing 1 1.6 Total 61 100.0
Table 46. Placement funding source: young people placed in voluntary or private sector Birmingham and the Black Country SHA
Joint funding arrangements underpin over three-fifths of all placements.
Costs of placements
Average costs are shown in table 47. Cost information was not returned in 6 cases; the information below is therefore based on 55 cases.
Average weekly Maximum weekly Funder cost per placement cost placement (£) (£)
PCT 3186 4459
PCT + SSD 2781 4890
PCT + SSD + 1546 4944 Education
Table 47. Average costs to funders of placements for young people commissioned in the private and voluntary sectors: Birmingham and the Black Country SHA
Note: complete cost information was only returned in 55 cases. No LEA cost information was available.
Total NHS + SSD weekly costs of all 55 placements in the census week: £145,480 ‘A census day audit of mental health independent sector placements in the West Midlands’ 52 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Total weekly cost to NHS funders in the census week: £ 97,368
Total weekly cost to SSD funders in census week £ 4,670
For the 55 CAMHS cases returned, the annual NHS + SSD costs are approximately £7.57 million. LEA costs are additional to this.
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether young people placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 48.
Named Care co- Percent District of Percent professional ordinator origin (Number) consultant (Number) Yes 31 50.8 27 44.3 No 7 11.5 3 4.9 Don’t know 23 37.7 31 50.8 Total 61 100 61 100
Table 48. Children and adolescents with Care Co-ordinator and District of origin consultant at point of census: Birmingham and the Black Country SHA private and voluntary placements
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each young person placed, during the 12 month period preceding the census date. Table 49 indicates the number who affirmed that they had received this feedback.
‘A census day audit of mental health independent sector placements in the West Midlands’ 53 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 13 (21.3) 30 (49.2) 18 (29.5) care co-ordinator Verbal report from 6 (9.8) 18 (29.5) 37 (60.7) care co-ordinator Written report from 22 (36.1) 22 (36.1) 17 (27.9) service provider Verbal report from 8 (13.1) 16 (26.2) 37 (60.7) service provider Visit to placement by 11 (18.0) 26 (42.6) 24 (39.3) commissioner Care review attended 12 (19.7) 28 (45.9) 21 (34.4) by commissioner Written carer or 4 (6.6) 37 (60.7) 20 (32.8) relative contact Verbal carer or 5 (8.2) 18 (29.5) 38 (62.3) relative contact Written patient 1 (1.6) 38 (62.3) 22 (36.1) contact Verbal patient 6 (9.8) 15 (24.6) 40 (65.6) contact 0 40 (65.6) 21 (34.4) Healthcare commission reports 1 (1.6) 40 (65.6) 20 (32.8) Mental Health Act Commission Report
Table 49. Feedback to commissioners: Birmingham and the Black Country SHA private and voluntary placements of children and adolescents
Reasons for placement
Reasons given for placements are shown in table 50.
Reasons for Number Percent placement Lack of local capacity 25 41.0 Lack of local capability 16 26.2 Most appropriate to needs 4 6.6 Don't know 16 26.2 Total 61 100.0
Table 50. Reasons for placements of children and adolescents in the private and voluntary sectors: Birmingham and the Black Country SHA
The largest group are placed because of problems of local capacity.
‘A census day audit of mental health independent sector placements in the West Midlands’ 54 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as for adults and older people. Of the sixty-one placements for children and adolescents made by organizations within the Birmingham and the Black Country SHA, 51(83.6%) were outside of the usual boundaries of the funding authority.
Average distance to placement (58 cases): 53.7 miles (Range 3 – 195 miles)
Providers used for children and adolescents by Birmingham and the Black Country commissioners
A total of 32 providers were used for 59 placements. Twenty-five providers had only one placement from Birmingham and the Black Country on the census day.
The 7 organisations providing more than one placement on the census day are listed in table 51.
Provider organisation Number (%) of young people placed at census date
The Priory Group 9 (14.8) Huntercombe Hospitals 7 (11.5) Young Options 5 (8.2) St.Andrew’s Hospital 5 (8.2) Sunfield School 4 (6.6) Autism West Midlands 2 (3.3) Caldecott Foundation 2 (3.3)
‘A census day audit of mental health independent sector placements in the West Midlands’ 55 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Table 51. Private and voluntary sector providers used for children and adolescents: Birmingham and the Black Country STA
Table 52 shows the numbers of young people placed broken down according to the provider trusts responsible for normal statutory services in the Birmingham and the Black Country SHA.
Usual statutory Mental Health Number (%) of young people Provider Trust placed in private or voluntary facilities on census date
Birmingham and Solihull MH 38 (62.3) NHS Trust Dudley Beacon and Castle PCT 4 (6.6) Sandwell MH NHS and Social 1 (1.6) Care Trust Walsall teaching PCT 13 (21.3) Wolverhampton City PCT 5 (8.2)
Table 52. Numbers of children and adolescents placed and usual statutory provider
Birmingham and Solihull MH NHS Trust is the usual statutory provider for the greatest number of placements made outside of the statutory sector, for young people.
‘A census day audit of mental health independent sector placements in the West Midlands’ 56 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Forensic placements (special commissioning) funded by PCTs in Birmingham and the Black Country
Gender, age and ethnicity of forensic patients placed
Fifty-two forensic placements were identified in the census in the Birmingham and the Black Country SHA. Demographic details are shown in table 53.
Forensic patients in Summary statistics private/voluntary sector
Gender Number (%) male 37 (71.2) Number (%) female 15 (28.8)
Age Mean age years (range) 36 (16-68)
Ethnicity (number %) White British 33 (63.5) Black Caribbean 16 (30.8) Indian 1 (1.9) Other black background 1 (1.9) Missing information 1 (1.9)
Table 53. Gender, age and ethnicity of individuals placed in private/voluntary forensic facilities: Birmingham and the Black Country SHA
Principal psychiatric diagnoses
Known diagnoses are shown in table 54.
Principal psychiatric diagnosis Number Percent (forensic patients) Schizophrenia 27 51.9 Schizo-affective disorder 1 1.9 Other psychotic disorder 1 1.9 Personality disorder 21 40.4 Autism/Asperger's syndrome 2 3.8 Total 52 100.0
Table 54. Principal diagnoses of individuals placed in private/voluntary forensic facilities: Birmingham and the Black Country SHA
Over half of the patients in forensic placements are diagnosed with psychotic illnesses.
‘A census day audit of mental health independent sector placements in the West Midlands’ 57 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Sixty-seven people (8.6%)were identified as having additional problems of alcohol dependence, and a further eighteen had problems of drug dependence. Forty-seven (6.0%) had additional problems of learning disability. Eight people were said to have problems of deafness. In large proportions of cases these additional factors were ‘not known’.
Legal status of forensic patients placed
Table 55 shows the legal status of the forensic patients placed in private or voluntary facilities.
Mental Health Act status Number Percent
Informal 1 1.9 Section 3 15 28.8 Section 37 5 9.6 Section 37/41 17 32.7 Section 38 6 11.5 Section 47/49 7 13.5 Don't know 1 1.9 Total 52 100.0
Table 55. Mental Health Act status of individuals placed in private or voluntary forensic facilities: Birmingham and the Black Country SHA
The largest group (17 individuals) are detained under Section 37/41 of the Act.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the individual placed. In 46 (88.5%) cases the placement was said to be appropriate, whilst in 6 cases (11.5%) it was not appropriate.
The placements
Table 56 indicates the sector of forensic placements in Birmingham and the Black Country.
Sector of placement Number Percent
Private 40 76.9 Voluntary 12 23.1 Total 52 100
‘A census day audit of mental health independent sector placements in the West Midlands’ 58 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Table 56 Sector of forensic provision: Birmingham and the Black Country SHA
Most placements are within the private sector.
Types of placement are shown in table 57.
Type of placement Number Percent
Medium secure unit 50 96.2 Rehabilitation unit 1 1.9 Women only unit 1 1.9 Total 52 100.0
Table 57. Types of forensic placements in private or voluntary sector: Birmingham and the Black Country SHA.
The majority of placements were described as medium secure units.
All 52 placements were funded solely by the NHS.
Costs of placements
Mean cost per placement £ 3,168
Maximum cost of forensic placement £ 4,249
Total weekly costs of all 52 placements in the census week: £164,738
For the 52 private and voluntary sector forensic placements, the annual total cost is approximately £8.6 million.
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether individuals placed in private or voluntary forensic facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 58.
‘A census day audit of mental health independent sector placements in the West Midlands’ 59 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Named Care co- Percent District of Percent professional ordinator origin (Number) consultant (Number) Yes 47 90.4 23 44.2 No 3 5.8 29 55.8 Don’t know 2 3.8 0 - Total 52 100 52 100
Table 58. Forensic patients with Care Co-ordinator and District of origin consultant at point of census: Birmingham and the Black Country SHA private and voluntary placements
In 47 cases (90.4%) either a care co-ordinator or a district-of-origin consultant, or both, was identified.
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each individual placed, during the 12 month period preceding the census date. Table 59 indicates the number who affirmed that they had received this feedback.
Reports from care co-ordinators and service providers appear to be the principal sources of feedback. Commissioner visits to placements, and contacts with patients, are also evident in a large number of cases.
‘A census day audit of mental health independent sector placements in the West Midlands’ 60 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 41 (78.8) 11 (21.2) 0 care co-ordinator Verbal report from 19 (36.5) 33 (63.5) 0 care co-ordinator Written report from 49 (94.2) 3 (5.8) 0 service provider Verbal report from 24 (46.2) 28 (53.8) 0 service provider Visit to placement by 34 (65.4) 18 (34.6) 0 commissioner Care review attended 38 (73.1) 14 (26.9) 0 by commissioner Written carer or 2 (3.8) 50 (96.2) 0 relative contact Verbal carer or 4 (7.7) 48 (92.3) 0 relative contact Written patient 3 (5.8) 49 (94.2) 0 contact Verbal patient 33 (63.5) 19 (36.5) 0 contact 29 (55.8) 22 (42.3) 1 (1.9) Healthcare commission reports 0 52 (100) 0 Mental Health Act Commission Report
Table 59. Feedback to commissioners: Birmingham and the Black Country SHA private and voluntary forensic placements
Reasons for placement
Reasons given for placements are shown in table 60.
Reasons for placement Number Percent
Lack of local capacity 30 57.7 Lack of local capability 21 40.4 Other 1 1.9 Total 52 100.0
Table 60. Reasons for forensic placements in the private and voluntary sectors: Birmingham and the Black Country SHA
‘A census day audit of mental health independent sector placements in the West Midlands’ 61 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as described for all placements.
Of the 52 forensic placements made by organizations within the Birmingham and the Black Country SHA, none were within the usual boundaries of the funding authority.
Average distance to placement: 91.3 miles (Range 9 – 160 miles)
Providers used for forensic placements by Birmingham and the Black Country commissioners
A range of units is used in the forensic sector. All providers are listed in table 61.
Provider organisation or unit Number Percent
Craegmoor Healthcare Ltd 1 1.9 The Priory Group 1 1.9 Blenheim Health Care Ltd 6 11.5 Anchor Trust 1 1.9 St Andrews Hospital 12 23.1 Partnerships in Care Ltd 23 44.2 Safe Spaces Ltd 1 1.9 Florence Nightingale Hospitals Ltd 2 3.8 Anwick House Ltd 1 1.9 Care Principles Ltd 4 7.7 Total 52 100.0
Table 61. Providers used for forensic placements: Birmingham and the Black Country SHA
Partnerships in Care Ltd are the dominant provider of forensic placements outside of the statutory sector.
Table 62 shows the numbers of forensic placements broken down according to the provider trusts responsible for normal statutory services in the Birmingham and the Black Country SHA.
‘A census day audit of mental health independent sector placements in the West Midlands’ 62 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Usual statutory Mental Health Number (%) of forensic Provider Trust placements in private or voluntary facilities on census date
Birmingham and Solihull MH 36 (69.2) NHS Trust Dudley Beacon and Castle PCT 6 (11.5) Sandwell MH NHS and Social 4 (7.7) Care Trust Walsall teaching PCT 2 (3.8) Wolverhampton City PCT 4 (7.7)
Table 62. Numbers of forensic placements and usual statutory provider
Birmingham and Solihull MH NHS Trust is the usual statutory provider for the greatest number of forensic placements made outside of the statutory sector.
‘A census day audit of mental health independent sector placements in the West Midlands’ 63 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Appendix 5 – West Midlands South Strategic Health Authority
Adults up to 64 years of age
Gender, age and ethnicity of people placed
Demographic details are shown in table 63.
Adults in private/voluntary Summary statistics sector
Gender Number (%) male 230 (66.9) Number (%) female 114 (33.1)
Age Mean age in years, range of 46 (18-64) ages
Ethnicity (number %) 287 (83.4) White British 6 (1.7) Irish 2 (0.6) Other white background 1 (0.3) White and Asian 3 (0.9) Any other mixed background 8 (2.3) Indian 1 (0.3) Pakistani 9 (2.6) Caribbean 1 (0.3) African 1 (0.3) Any other 25 (7.3) Missing information (number (%) of cases) 344 (100) TOTAL
Table 63. Gender, age and ethnicity of adults (under 65) placed in private/voluntary facilities: West Midlands South SHA
Twice the number of men are placed in the private or voluntary sectors than women. Many women may be placed in facilities catering for larger numbers of men. There was no significant difference between men and women in terms of age.
The population placed is predominantly white British.
‘A census day audit of mental health independent sector placements in the West Midlands’ 64 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Principal psychiatric diagnoses
Categories of ‘diagnosis’ were selected to reflect some of the more unusual syndromes, where lack of local capability might lead to placement in the independent sector.
Known diagnoses are shown in table 64.
Psychiatric diagnoses Frequency Percent
Huntington's Chorea 4 1.2 Korsakoff's Syndrome 17 4.9 Early onset dementia 15 4.4 Acquired brain injury 4 1.2 Other organic condition 4 1.2 Schizophrenia 152 44.2 Schizo-affective disorder 9 2.6 Bi-polar disorder/affective psychosis 8 2.3 Other psychotic disorder 3 0.9 Depression 10 2.9 Anxiety disorder 1 0.3 Other neurotic disorder 2 0.6 Eating disorder 4 1.2 Personality disorder 18 5.2 Autism/Asperger's syndrome 14 4.1 Other 9 2.6 Non-specific mental illness 69 20.1 Dementia 1 0.3 Total 344 100.0
Table 64. Principal diagnoses of adults (under 65) placed in private/voluntary facilities: West Midlands South SHA
Around half of adults placed have known psychotic illnesses, and a significant number (one fifth) have no known specific diagnosis. The remainder include people with diagnoses that may be harder to provide for within mainstream services.
Additional problems of alcohol dependence were recorded in 33 cases (9.6%) and drug dependence in 20 cases (5.8%).
Additional problems of learning disability were recorded in 37 cases (10.8%), and deafness in 8cases (2.3%).
Unfortunately in each of these areas it was not known if additional problems existed in nearly one quarter of all cases.
‘A census day audit of mental health independent sector placements in the West Midlands’ 65 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Legal status of individuals placed
Table 65 shows the legal status of adults placed in private or voluntary facilities.
Mental Health Act 1983 status Frequency Percent
Informal 154 44.8 Section 2 4 1.2 Section 3 26 7.6 Section 7 (Guardianship) 2 0.6 Section 25 1 0.3 Section 37 12 3.5 Section 37/41 14 4.1 Section 38 1 0.3 Section 117 54 15.7 Don't know 75 21.8 Section 47/49 1 0.3 Total 344 100.0
Table 65. Mental Health Act status of adults placed in private or voluntary facilities: West Midlands South SHA
Most individuals are placed as informal patients, or as part of arrangements following detention under Section 3. A further group are subject to formal detention under Part 2 of the Act, and an even smaller group are placed under Part 3 (forensic provisions). In a significant number of cases the legal status was not known.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the individual placed. In 254 cases (73.8%) commissioners indicated that the placement was appropriate, in 20 cases (5.8%) the placement was not appropriate, whilst in 70 cases (20.3%) the commissioner completing the form did not know whether the placement was appropriate or not.
The placements
Table 66 indicates the sector of placements used in West Midlands South.
Sector Number Percent
Private 261 75.9 Voluntary 83 24.1 Total 344 100.0 ‘A census day audit of mental health independent sector placements in the West Midlands’ 66 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 66. Sector of provision for adults under 65: West Midlands South SHA
It is clear that the private market dominates provision outside of the statutory agencies.
Types of placement are shown in table 67.
Type of placement (adults <65) Frequency Percent
Psychiatric Intensive Care Unit 14 4.1 Low secure/high dependency unit 12 3.5 Medium secure unit 40 11.6 Rehabilitation unit 12 3.5 Continuing care service 261 75.9 Specialist eating disorder facility 4 1.2 Total 343 99.7 Missing 1 0.3 Total 344 100.0
Table 67. Types of adult placements in private or voluntary sector: West Midlands South SHA.
Longer term or non-specialist units predominate in overall provision.
Types of Healthcare Commission and Commission for Social Care Inspection registration are shown in table 68.
Type of registration Number Percent
Independent hospital 77 22.4 Care home with nursing 98 28.5 Care home 168 48.8 Total 343 99.7 Missing 1 0.3
Table 68. Type of registration: West Midlands South SHA adult placements
Independent hospitals, care homes with nursing and care homes were all provided by the both private and the voluntary sectors.
Placements were funded in a variety of ways. Table 69 shows the funding sources.
‘A census day audit of mental health independent sector placements in the West Midlands’ 67 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Funder of placement Number Percent
Health 91 26.5 Social services 175 50.9 Joint health & social services 77 22.4 Total 343 99.7 Missing 1 0.3 Total 344 100.0
Table 69. Placement funding source: adults placed in voluntary or private sector West Midlands South SHA
Sole Social Services funded placements account for the greatest proportion of the funding arrangements, nearly twice the number funded sole by Health. Sole NHS funding was significantly more likely to underpin placements in independent hospitals, whilst sole Social Services funding was more likely for facilities described as ‘care homes’. Joint funding was used for all types of placements, although care home placements predominated.
Costs of placements
Average costs are shown in table 70.
Average weekly Maximum weekly Type of funding cost per placement cost placement (£) (£)
Health service only 821 6550
LA Social Services 303 1447 only
Joint 1182 3168
Average added cost 0 0 of ‘specialing’
All placements 1127 6550
Table 70. Average costs of adult placements commissioned in the private and voluntary sectors: West Midlands South SHA
Note: Cost information missing in 4 cases (not included)
Total weekly costs of all placements in the census week: £383,212
Total weekly cost to NHS funders in the census week: £279,117
‘A census day audit of mental health independent sector placements in the West Midlands’ 68 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Total weekly cost to LASSD funders in the census week: £104,095
If the census week is assumed to be typical, current TOTAL costs approximate £19.93 million per annum for adults under 65 years of age placed by PCTs and LASSDs in the West Midlands South strategic health authority area.
Health funding predominates in the high-cost placements, and health funding also underpins a greater number of placements, leading to higher overall costs to the NHS.
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether individuals placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 71.
Named Care Co- Percent District of Percent professional ordinator origin (number) consultant (number) Yes 241 70.1 141 41.0 No 60 17.4 66 19.2 Don't know 43 12.5 137 39.8 Total 344 100.0 344 100.0
Table 71. Individuals with Care Co-ordinator and District of origin consultant at point of census: West Midlands South SHA private and voluntary placements
When these figures are combined, a total of 266 (77.3%) out of 344 individuals placed are known to have either a named care co-ordinator, or a named District of origin consultant, or both. However, a minority do not have this formal linkage. The study was not designed to establish the robustness or otherwise of the formal links.
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each individual placement during the 12 month period preceding the census. Table 72 indicates the number who affirmed that they had received this feedback.
‘A census day audit of mental health independent sector placements in the West Midlands’ 69 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 163 (47.4) 95 (27.6) 86 (25.0) care co-ordinator Verbal report from 94 (27.3) 110 (32.0) 140 (40.7) care co-ordinator Written report from 85 (24.7) 166 (48.3) 93 (27.0) service provider Verbal report from 107 (41.9) 144 (41.9) 93 (27.0) service provider Visit to placement by 54 (15.7) 203 (59.0) 83 (24.1) commissioner Care review attended 65 (18.9) 196 (57.0) 71 (28.0) by commissioner Written carer or 20 (5.8) 242 (70.3) 82 (23.8) relative contact Verbal carer or 49 (14.2) 209 (60.8) 86 (25.0) relative contact Written patient 20 (5.8) 246 (71.5) 78 (22.7) contact Verbal patient 109 (31.7) 156 (45.3) 79 (23.0) contact 55 (16.0) 186 (54.1) 103 (29.9) Healthcare commission reports 5 (1.5) 259 (75.3) 80 (23.3) Mental Health Act Commission Report
Table 72. Feedback to commissioners: West Midlands South SHA private and voluntary placements (adults <65)
It must be acknowledged that there were inconsistencies between areas in the way in which the census forms were completed, and many were not completed directly by commissioners but by others in the organization. The information contained in table 13 is therefore broadly indicative only of the use of various channels of feedback.
Reasons for placement
Reasons given for placements are shown in table 73.
‘A census day audit of mental health independent sector placements in the West Midlands’ 70 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Reasons for placement Number Percent
Lack of local capacity 39 11.3 Lack of local capability 65 18.9 Other 21 6.1 Don't know 132 38.4 Most appropriate to 76 22.1 needs Family Reasons 11 3.2 Total 344 100.0
Table 74. Reasons for placements of adults under 65 years of age in the private and voluntary sectors: West Midlands South SHA
The largest single group of reasons are ‘not known’, but issues of capacity and capability also feature prominently in the reasons for placement.
Distance from district of origin
As the research team did not have access to home addresses of individuals placed, distances were calculated from the post-code of the PCT or Local Authority funding the placement, and from the post-code of the placement itself. This gives an approximate indication of distances involved, although in county and rural areas the margin of error in approximating ‘distance from home’ will be greater.
Of all adult placements made by organizations within the West Midlands South SHA, 184 (53.5%) were identified as being within the geographical catchment area of the funding PCT or LASSD; 159 (46.2%) were outside of the funder’s normal catchment area.
Average distance to placement: 36.3 miles (Range 0.3 – 281 miles)
Average distance to placements outside of PCT or LASSD catchment: 68.4 miles (Range 9 -281 miles)
Table 75 shows the distance from area of origin according to the placement sector.
Distance to placement from Sector Total commissioner address Private Voluntary
0-20 miles Number 141 48 189 % within Sector 74.6% 25.4% 100.0% 21-50 miles Number 48 24 72 % within Sector 66.7% 33.3% 100.0% over 50 miles Number 63 9 72 % within Sector 87.5% 12.5% 100.0% Total Number 230 252 81 % within Sector 100.0% 75.7% 24.3%
‘A census day audit of mental health independent sector placements in the West Midlands’ 71 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 75. Distance to placement in bands by placement sector: West Midlands South SHA (adults up to 65 years)
Just under three-quarters of all adult placements are within 20 miles of the funding PCT or LASSD. The remainder, most of which are private sector placements, are further afield.
Providers used by West Midlands South commissioners
A total of 144 establishments were used as placements for adults under 65 years of age, on the date of the census.
Of these, 75 had only one person placed with them funded by the West Midlands South Commissioners. Nineteen providers had 5 or more people placed with them, funded by West Midlands South PCTs or LASSDs on the census date. Table 76 shows the most commonly-used providers.
Provider organisation Number (%) of people placed at census date
Rethink 24 (7.0) St Andrews Hospital 20 (5.8) Travid Enterprises Ltd 17 (4.9) Partnerships In Care Ltd 16 (4.7) Craegmoor Healthcare Ltd 12 (3.5) Eden Place Ltd 12 (3.5) MIND 9 (2.6) Prime Life Ltd 9 (2.6) Blenheim Health Care Ltd 8 (2.3) Shenstone House 8 (2.3) FCH 8 (2.3) Advance Housing & Support Ltd 8 (2.3) Aston House 7 (2.0) Cygnet Health Care 7 (2.0) TRACS 7 (2.0) Credenhill Court 7 (2.0) Shaw Healthcare Homes Ltd 6 (1.7) Manor Rest Home 6 (1.7) Focus Housing Association 5 (1.5)
Table 76: Most commonly used providers for adults: West Midlands South SHA
Just over half of all census day placements were provided by these 19 organisations.
Table 77 shows the numbers placed broken down according to the provider trusts responsible for normal statutory services in the West Midlands South SHA.
‘A census day audit of mental health independent sector placements in the West Midlands’ 72 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Usual statutory Mental Health Number (%) of adults placed Provider Trust in private or voluntary facilities on census date
Coventry Teaching PCT 85 (24.7) Worcs MH Partnership NHS Trust 75 (21.8) Herefordshire PCT 74 (21.5) North Warwickshire PCT 68 (19.8) South Warwickshire PCT 42 (12.2)
Table 77. Numbers placed by usual statutory provider
‘A census day audit of mental health independent sector placements in the West Midlands’ 73 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Older people aged 65 years and over
Gender, age and ethnicity of older people placed
Demographic details are shown in table 78.
Older people in Summary statistics private/voluntary sector
Gender Number (%) male 58 (30.7) Number (%) female 131 (69.3)
Age Mean age in years, range of 77.1 (65-102) ages
Ethnicity (number %) 177 (93.7) White British 4 (2.1) Irish 3 (1.6) Caribbean 1 (0.5) Any other white background 1 (0.5) Indian 3 (1.6) Missing information
Table 78. Gender, age and ethnicity of older people (65 and over) placed in private/voluntary facilities: West Midlands South SHA
More women than men are placed in the private or voluntary sectors in the older age group. However, this reflects the population proportions.
Principal psychiatric diagnoses
Categories of ‘diagnosis’ were selected to reflect some of the more unusual syndromes, where lack of local capability might lead to placement in the independent sector. Older people with organic illnesses funded solely by Social Services were excluded.
Known diagnoses are shown in table 79.
‘A census day audit of mental health independent sector placements in the West Midlands’ 74 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Principal psychiatric diagnosis Number Percent
Dementia 137 72.5 Principal Mental illness 28 14.8 Schizophrenia 10 5.3 Depression 5 2.6 Bi-polar disorder/affective psychosis 3 1.6 Huntington's Chorea 1 0.5 Early onset dementia 1 0.5 Acquired brain injury 1 0.5 Other organic condition 1 0.5 Other psychotic disorder 1 0.5 Other 1 0.5 Total 189 100.0
Table 79. Principal diagnoses of older people (65 years and over) placed in private/voluntary facilities: West Midlands South SHA
The majority of older people placed have known dementia which probably reflects the fact that many of these placements have health funding components.
Additional problems of alcohol dependence were recorded in 2 cases only and drug dependence in no cases.
Additional problems of learning disability was recorded in 1 case, and deafness in 3 cases. However, in a majority of cases, these additional factors were recorded as ‘not known’.
Legal status of older individuals placed
Table 80 shows the legal status of older people placed in private or voluntary facilities.
Mental Health Act 1983 status Number Percent
Informal 156 82.5 Don't know 23 12.2 Section 117 7 3.7 Section 3 1 0.5 Section 37 1 0.5 Section 37/41 1 0.5 Total 189 100.0
Table 80. Mental Health Act status of older people placed in private or voluntary facilities: West Midlands South SHA
‘A census day audit of mental health independent sector placements in the West Midlands’ 75 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Most individuals are placed as informal patients, or as part of Section 117 arrangements following detention under Section 3. The proportion where legal status was not known is also significant.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the older person placed. In 162 cases (85.7%) commissioners indicated that the placement was appropriate, in three cases the placement was not appropriate, whilst in 24 cases (12.7%) the commissioner completing the form did not know whether the placement was appropriate or not. (This is a higher proportion of ‘not known’ responses than for adults under 65.)
The placements
Table 81 indicates the sector of placements used for older people in West Midlands South.
Sector of placement Number Percent
Private 171 90.5 Voluntary 18 9.5 Total 160 189
Table 81. Sector of provision for older people aged 65 and over: West Midlands South SHA
The dominance of private over voluntary provision is as marked as in the adult sector.
Types of placement are shown in table 82.
Type of placement Number Percent
Continuing care service 185 97.9 Psychiatric Intensive Care Unit 4 2.1 Total 189 100.0
Table 82. Types of placements for older people in private or voluntary sector: West Midlands South SHA.
Continuing care units predominate in overall provision.
Types of registration with the Healthcare Commission and Commission for Social Care Inspection are shown in table 83.
‘A census day audit of mental health independent sector placements in the West Midlands’ 76 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Type of registration Number Percent
Care home 123 65.1 Care home with nursing 61 32.3 Independent hospital 5 2.6 Total 189 100
Table 83. Type of registration: West Midlands South SHA placements for older people
Placements were funded in a variety of ways. Table 84 shows the funding sources.
Funder(s) Number of Percent placements Joint health & social services 114 60.3 Health 38 20.1 Social services 32 16.9 Total 184 97.4 Missing 5 2.6 Total 189 100.0
Table 84. Placement funding source: older people placed in voluntary or private sector West Midlands South SHA
Social Services authorities are the sole funder for a far smaller proportion of placements than is the case in the adult sector. Joint funding arrangements are predominate with this client group.
Average weekly Maximum weekly Type of funding cost per placement cost placement (£) (£)
Health service only 569 2485
LA Social Services 363 523 only
Joint 453 1219
All placements 459 2485
‘A census day audit of mental health independent sector placements in the West Midlands’ 77 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Table 85. Average costs of placements for older people commissioned in the private and voluntary sectors: West Midlands South SHA
Note: Cost information missing in 4 cases
Total weekly costs of all placements in the census week: £58,174
Total weekly cost to NHS funders in the census week: £16,212
Total weekly cost to LASSD funders in the census week: £43,176
If the census week is assumed to be typical, current TOTAL costs approximate £3.03 million per annum for older people aged 65 years of age and over, placed by PCTs and LASSDs in the West Midlands South strategic health authority area.
For older people Social Services fund far more placements numerically, and also bear the highest overall cost burden.
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether older people placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 86.
Named Care co- Percent District of origin Percent professional ordinator consultant (Number) (Number) Yes 79 41.8 37 19.6 No 98 51.9 76 40.2 Don't know 12 6.3 76 40.2 Total 189 100.0 189 100
Table 86. Older people with Care Co-ordinator and District of origin consultant at point of census: West Midlands South SHA private and voluntary placements
When these figures are combined, a total of 82 (42.5%) out of 193 individuals placed have either a named care co-ordinator, or a named District of origin consultant, or both. However, a minority do not have this formal linkage.
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each older person placed, during the 12 month period preceding the
‘A census day audit of mental health independent sector placements in the West Midlands’ 78 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) census date. Table 87 indicates the number who affirmed that they had received this feedback.
Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 97 (51.3) 59 (31.2) 33 (17.5) care co-ordinator Verbal report from 3 (1.6) 43 (22.8) 143 (75.7) care co-ordinator Written report from 5 (2.6) 157 (83.1) 27 (14.3) service provider Verbal report from 4 (2.1) 154 (81.5) 31 (16.4) service provider Visit to placement by 28 (14.8) 133 (70.4) 28 (14.8) commissioner Care review attended 32 (16.9) 130 (68.8) 27 (14.3) by commissioner Written carer or - 135 (71.4) 54 (28.6) relative contact Verbal carer or 1 (0.5) 135 (71.4) 53 (28.0) relative contact Written patient 1 (0.5) 162 (85.7) 26 (13.8) contact Verbal patient 7 (3.7) 157 (83.1) 25 (13.2) contact 29 (15.3) 134 (70.9) 26 (13.8) Healthcare commission reports - 164 (86.8) 25 (13.2) Mental Health Act Commission Report
Table 87. Feedback to commissioners: West Midlands South SHA private and voluntary placements of older people
In a large number of cases, those completing the census forms did not have access to information about this type of feedback, explaining the high number of ‘not known’ responses.
Reasons for placement
Reasons given for placements are shown in table 88.
‘A census day audit of mental health independent sector placements in the West Midlands’ 79 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Reasons for placements Number Percent
Don't know 138 73.0 Other 29 15.3 Family Reasons 11 5.8 Lack of local capability 6 3.2 Most Appropriate to Needs 4 2.1 Lack of local capacity 1 0.5 Total 189 100.0
Table 88. Reasons for placements of older people aged 65 years and over in the private and voluntary sectors: West Midlands South SHA
Many placements are likely to be long-standing, and the original reasons for placement may be unavailable.
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as for adults. Of all placements of older people made by organizations within the West Midlands South SHA, 162 (85.7%) were identified as being within the geographical catchment area of the funding PCT or LASSD; only 26 (13.8%) were outside of the funder’s normal catchment area. This is a significantly different picture to that of adult placements where a significantly high proportion of placements are outside the funder’s catchment area.
Average distance to placement: 18.0 miles (Range 0.7 – 186 miles)
Providers used by West Midlands South commissioners
A total of 66 establishments were used as placements for older people, on the date of the census. Of these, 34 had only one person placed with them funded by the West Midlands South Commissioners. Only 10 providers had 5 or more people placed with them, funded by West Midlands South PCTs or LASSDs on the census date. Table 89 shows the most commonly-used providers.
‘A census day audit of mental health independent sector placements in the West Midlands’ 80 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Provider organisation Number (%) of people placed at census date
Holmer Nursing Home 24 (12.7) Gildawood Court Residential Homes Ltd 19 (10.1) Roxburgh House 10 5.3 () Pinnacle Care Ltd 9 (4.8) Craighaven 9 (4.8) Chasewood Case Ltd 9 (4.8) Shaw Healthcare Homes Ltd 8 (4.2) St Andrews Hospital 5 (2.6) Merevale House 5 (2.6) Stonebridge Nursing Home 5 (2.6)
Table 89: Most commonly used providers for older people: West Midlands South SHA
The provision is generally dispersed with most providers having very small numbers.
Table 90 shows the numbers placed broken down according to the provider trusts responsible for normal statutory services in the West Midlands South SHA.
Usual statutory Mental Health Number of out-of- Percent Provider Trust sector placements North Warwickshire PCT 88 46.6 South Warwickshire PCT 40 21.2 Herefordshire PCT 29 15.3 Worcs MH Partnership NHS Trust 25 13.2 Coventry Teaching PCT 7 3.7 Total 189 100.0
Table 90. Numbers of older people placed on census date, and usual statutory provider
North Warwickshire PCT is the usual statutory provider for the greatest number of placements of older people made outside of the statutory sector.
‘A census day audit of mental health independent sector placements in the West Midlands’ 81 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Children and adolescents (in CAMHS)
Gender, age and ethnicity of children and adolescents placed
Thirty-nine users of child and adolescent mental health services in the voluntary and private sectors (including placements in residential schools for ‘mental health’ reasons) were identified in the census in the West Midlands South SHA. Demographic details are shown in table 91.
Children and adolescents in Summary statistics private/voluntary sector
Gender Number male 1 (10.0) Number female 9 (90.0)
Age Mean (years), range 15.5 (13-17)
Ethnicity (number %) White British 8 (80.0%) Information not provided 2 (20.0%)
Table 91. Gender, age and ethnicity of children and adolescents placed in private/voluntary facilities: West Midlands South SHA
Principal psychiatric diagnoses
Known diagnoses are shown in table 92.
Known principal diagnosis Number Percent
Eating disorder 6 60.0 Other psychotic disorder 1 10.0 Depression 1 10.0 Other 1 10.0 Non-specific mental illness 1 10.0 Total 10 100.0
Table 92. Principal diagnoses of children and adolescents placed in private/voluntary facilities: West Midlands South SHA
Over half of the young people are diagnosed with eating disorders.
‘A census day audit of mental health independent sector placements in the West Midlands’ 82 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) No additional problems of drug dependence or alcohol dependence were recorded. In one case deafness was also recorded and in one case problems of learning disability were recorded
Legal status of young people placed
Table 93 shows the legal status of the young people placed in private or voluntary facilities.
Legal status of young people Number Percent in private/voluntary provision Informal 5 50.0 Don't know 3 30.0 Section 3 1 10.0 Children Act Provision 1 10.0 Total 10 100.0
Table 93. Mental Health Act status of children and adolescents placed in private or voluntary facilities: West Midlands South SHA
The largest group (5 young people) are informal patients.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the young person placed. In 6 cases the placement was said to be appropriate, in a worrying 4 cases it was not appropriate’.
The placements
All of the 10 placements used for young people in West Midlands South were in the private sector.
Most young people are placed within the private sector.
Types of placement are shown in table 94.
Type of placement Number Percent
Specialist eating disorder facility 5 50.0 Acute in-patient ward 1 10.0 Psychiatric Intensive Care Unit 1 10.0 Psychotherapy service (in-patient) 1 10.0 Other service 1 10.0 CAMHS Residential Unit 1 10.0 Total 10 100.0 ‘A census day audit of mental health independent sector placements in the West Midlands’ 83 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 94. Types of placements for young people in private or voluntary sector: West Midlands South SHA.
Placements were funded in a variety of ways. Table 95 shows the funding sources.
Funder(s) Number of Percent placements Health 7 70.0 Joint health & Social Services 2 20.0 Other 1 10.0 Total 10 100
Table 95. Placement funding source: young people placed in voluntary or private sector West Midlands South SHA
The majority of placements are either funded totally or in part by health.
Costs of placements
Average costs are shown in table 96. Average weekly Maximum weekly Funder cost per placement cost placement (£) (£)
Health service 4337 9325
Health and SSDs 3789 3866
NB – one placement incurred variable costs of £6,420 for the week of the census.
Table 96. Average costs to NHS and LASSDs of placements for young people commissioned in the private and voluntary sectors: West Midlands South SHA
Note: complete cost information was returned in all cases.
Total NHS + SSD weekly costs of all 10 placements in the census week: £40,114
Total weekly cost to NHS funders in the census week: £33,481
Total weekly cost to SSD funders in census week £ 6,633
For the 10 CAMHS cases returned, the annual NHS and LASSD costs are approximately £2.09 million.
‘A census day audit of mental health independent sector placements in the West Midlands’ 84 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether young people placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 97.
Named Care co- Percent District of Percent professional ordinator origin (Number) consultant (Number) Yes 7 70.0 7 70.0 Don't know 2 20.0 2 20.0 No 1 10.0 1 10.0 Total 10 100.0 10 100.0
Table 97. Children and adolescents with Care Co-ordinator and District of origin consultant at point of census: West Midlands South SHA private and voluntary placements
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each young person placed, during the 12 month period preceding the census date. Table 98 indicates the number who affirmed that they had received this feedback.
‘A census day audit of mental health independent sector placements in the West Midlands’ 85 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 4 (40.0) 3 (30.0) 3 (30.0) care co-ordinator Verbal report from 6 (60.0) 2 (20.0) 2 (20.0) care co-ordinator Written report from 6 (60.0) 2 (20.0) 2 (20.0) service provider Verbal report from 2 (20.0) 6 (60.0) 2 (20.0) service provider Visit to placement by 2 (20.0) 6 (60.0) 2 (20.0) commissioner Care review attended 2 (20.0) 6 (60.0) 2 (20.0) by commissioner Written carer or 3 (30.0) 3 (30.0) 4 (40.0) relative contact Verbal carer or 4 (40.0) 3 (30.0) 3 (30.0) relative contact Written patient 1 (10.0) 7 (70.0) 2 (20.0) contact Verbal patient 1 (10.0) 7 (70.0) 2 (20.0) contact - 5 (50.0) 5 (50.0) Healthcare commission reports - 8 (80.0) 2 (20.0) Mental Health Act Commission Report
Table 98. Feedback to commissioners: West Midlands South SHA private and voluntary placements of children and adolescents
Reasons for placement
Reasons given for placements are shown in table 99.
Reason for placement Frequency Percen t Most appropriate to needs 4 40.0 Lack of local capacity 2 20.0 Lack of local capability 2 20.0 Other 2 20.0 Total 10 100.0
Table 99. Reasons for placements of children and adolescents in the private and voluntary sectors: West Midlands South SHA
‘A census day audit of mental health independent sector placements in the West Midlands’ 86 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Commissioners responding to the census identified a range of reasons for the placement.
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as for adults and older people.
Of the ten placements for children and adolescents made by organizations within the West Midlands South SHA, none were within the boundaries of the funding authority.
Average distance to placement (10 cases): 72.5 miles (Range 22 – 135miles)
Providers used for children and adolescents by West Midlands South commissioners
A total of 5 providers were used for the 12 placements. Two providers had only one placement from within the SHA area on the census day.
The 7 organisations providing more than one placement on the census day are listed in table 100.
Provider organisation Number (%) of young people placed at census date
The Priory Group 3 (30.0) Hunterscombe Hospitals 3 (30.0) Care UK PLC 2 (20.0) Florence Nightingale Hospitals Ltd 1 (10.0) Promoting Positive Lives Ltd 1 (10.0)
Table 100. Private and voluntary sector providers used for children and adolescents: West Midlands South STA
Table 101 shows the numbers of young people placed broken down according to the provider trusts responsible for normal statutory services in the West Midlands South SHA.
Usual statutory Mental Health Number (%) of young Provider Trust people placed in private or voluntary facilities on census date
Coventry Teaching PCT 3 (30.0) Herefordshire PCT 3 (30.0) North Warwickshire PCT 2 (20.0) Worcs MH Partnership NHS Trust 2 (20.0)
‘A census day audit of mental health independent sector placements in the West Midlands’ 87 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 101. Numbers of children and adolescents placed and usual statutory provider
Coventry Teaching PCT and Herefordshire PCT are the usual statutory service providers for the greatest number of placements made outside of the statutory sector, for young people.
‘A census day audit of mental health independent sector placements in the West Midlands’ 88 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Forensic placements (special commissioning) funded by PCTs in West Midlands South
Gender, age and ethnicity of forensic patients placed
Sixteen forensic placements were identified in the census in the West Midlands South SHA. Demographic details are shown in table 102.
Forensic patients in Summary statistics private/voluntary sector
Gender Number (%) male 27 (73.0) Number (%) female 10 (27.0)
Age Mean age years (range) 37 (18-63)
Ethnicity (number %) White British 33 (89.2) Black Caribbean 2 (5.4) Missing information (Number % 2 (5.4) of cases)
Table 102. Gender, age and ethnicity of individuals placed in private/voluntary forensic facilities: West Midlands South SHA
Principal psychiatric diagnoses
Known diagnoses are shown in table 103.
Principal psychiatric diagnosis Number Percent (forensic patients) Schizophrenia 22 59.5 Personality disorder 11 29.7 Non-specific mental illness 2 5.4 Schizo-affective disorder 1 2.7 Autism/Asperger's syndrome 1 2.7 Total 37 100.0
Table 103. Principal diagnoses of individuals placed in private/voluntary forensic facilities: West Midlands South SHA
‘A census day audit of mental health independent sector placements in the West Midlands’ 89 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Nearly two-thirds of the patients in forensic placements are diagnosed with psychotic illnesses. Seven (18.9%) people were identified as having additional problems of alcohol dependence and eight (21.6%) had additional problems with drug dependence. Three (8.1%) had additional problems of learning disability and three (8.1%) were identified as deaf.
Legal status of forensic patients placed
Table 104 shows the legal status of the six young people placed in private or voluntary facilities.
Mental Health Act status Number Percent
Section 3 14 37.8 Section 37 9 24.3 Section 37/41 9 24.3 Don't know 3 8.1 Section 2 1 2.7 Section 47/49 1 2.7 Total 37 100.0
Table 104. Mental Health Act status of individuals placed in private or voluntary forensic facilities: West Midlands South SHA
The largest group (14 individuals) are detained under Section 3 of the Act.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the person placed. In 32 cases the placement was said to be appropriate, whilst in 3 cases it was not appropriate. In a further 2 cases the suitability of the placement was not known.
The placements
Table 105 indicates the sector of forensic placements in West Midlands South.
Sector of placement Number Percent
Private 26 70.3 Voluntary 11 29.7 Total 16 37
Table 105. Sector of forensic provision: West Midlands South SHA ‘A census day audit of mental health independent sector placements in the West Midlands’ 90 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Most placements are within the private sector.
Types of placement are shown in table 106.
Type of placement Number Percent
Medium secure unit 35 94.6 Low secure/high dependency unit 1 2.7 Continuing care service 1 2.7 Total 37 100.0
Table 106. Types of forensic placements in private or voluntary sector: West Midlands South SHA.
The majority of placements were described as medium secure units.
Costs of placements
The funding source for the 37 forensic placements were health, no other sources of funding were used.
Average costs are shown in table 107. Cost information was returned in all 37 cases.
Average Maximum Type of funding weekly cost weekly per placement placement cost (£) (£)
Health service only (n=37) 3063 4249
Social Services - -
Table 107. Average costs of forensic placements commissioned in the private and voluntary sectors: West Midlands South SHA
Total weekly costs of all 37 placements in the census week: £113,344
Total weekly cost to NHS funders in the census week: £113,344
Total SSD costs in census week Nil
For the 37 forensic placements, the annual total cost is approximately £5.89 million.
‘A census day audit of mental health independent sector placements in the West Midlands’ 91 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether individuals placed in private or voluntary forensic facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 108.
Named Care co- Percent District of Percent professional ordinator origin (Number) consultant (Number) Yes 26 70.3 20 54.1 No 9 24.3 15 40.5 Don’t know 2 5.4 2 5.4 Total 37 100.0 37 100.0
Table 108. Forensic patients with Care Co-ordinator and District of origin consultant at point of census: West Midlands South SHA private and voluntary placements
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each individual placed, during the 12 month period preceding the census date. Table 109 indicates the number who affirmed that they had received this feedback.
‘A census day audit of mental health independent sector placements in the West Midlands’ 92 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 30 (81.1) 5 (13.5) 2 (5.4) care co-ordinator Verbal report from 25 (67.6) 10 (27.0) 2 (5.4) care co-ordinator Written report from 33 (89.2) 2 (5.4) 2 (5.4) service provider Verbal report from 24 (64.9) 11 (29.7) 2 (5.4) service provider Visit to placement by 13 (35.1) 22 (59.5) 2 (5.4) commissioner Care review attended 24 (64.9) 11 (29.7) 2 (5.4) by commissioner Written carer or 2 (5.4) 33 (89.2) 2 (5.4) relative contact Verbal carer or 7 (18.9) 28 (75.7) 2 (5.4) relative contact Written patient 4 (10.8) 31 (83.8) 2 (5.4) contact Verbal patient 24 (64.9) 11 (29.7) 2 (5.4) contact 26 (70.3) 9 (24.3) 2 (5.4) Healthcare commission reports 0 36 (97.3) 1 (2.7) Mental Health Act Commission Report
Table 109. Feedback to commissioners: West Midlands South SHA private and voluntary forensic placements
Written reports from care co-ordinators and service providers, and Healthcare Commission reports, appear to be the principal sources of feedback.
Reasons for placement
Reasons given for placements are shown in table 110.
Reason for placement Number Percent
Lack of local capability 27 73.0 Lack of local capacity 10 27.0 Total 37 100.0
Table 110. Reasons for forensic placements in the private and voluntary sectors: West Midlands South SHA
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as described for all placements. Of the 37 forensic placements made by organizations within the West Midlands South SHA, none were within the usual boundaries of the funding authority.
Average distance to placement: 90.7 miles (Range 27 – 281 miles)
Providers used for forensic placements by West Midlands South commissioners
A range of units is used in the forensic sector. All providers are listed in table 111.
Provider unit/ organisation Number Percent
Partnerships in Care Ltd 13 35.1 St Andrews Hospital 11 29.7 Blenheim Health Care Ltd 7 18.9 Anchor Trust 2 5.4 Affinity Healthcare 1 2.7 Safe Spaces Ltd 1 2.7 Florence Nightingale Hospitals 12.7 Ltd Stones Holdings Ltd 1 2.7 Total 37 100.0
Table 111. Providers used for forensic placements: West Midlands South SHA
Table 112 shows the numbers of forensic placements broken down according to the provider trusts responsible for normal statutory services in the West Midlands South SHA.
‘A census day audit of mental health independent sector placements in the West Midlands’ 94 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Usual statutory Mental Health Number (%) of forensic Provider Trust placements in private or voluntary facilities on census date
Coventry Teaching PCT 11 (29.7) North Warwickshire PCT 10 (27.0) Worcs MH Partnership NHS Trust 10 (27.0) Herefordshire PCT 6 (16.2)
Table 112. Numbers of forensic placements and usual statutory provider
Coventry Teaching PCT is the usual statutory provider for the greatest number of forensic placements made outside of the statutory sector.
‘A census day audit of mental health independent sector placements in the West Midlands’ 95 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Appendix 6 – Shropshire and Staffordshire Strategic Health Authority
Adults up to 64 years of age
Gender, age and ethnicity of people placed
Demographic details are shown in table 113.
Adults in private/voluntary Summary statistics sector
Gender Number (%) male 153 (60.2) Number (%) female 101 (39.8)
Age Mean age in years, range of 44 (18-64) ages
Ethnicity (number %) 229 (90.2) White British 2 (0.8) Irish 1 (0.4) Other white background 1 (0.4) White and Black Caribbean 1 (0.4) White and black African 2 (0.8) Indian 2 (0.8) Caribbean 1 (0.4) Any other 15 (5.9) Missing information (number (%) of cases) 254 (100) TOTAL
Table 113. Gender, age and ethnicity of adults (under 65) placed in private/voluntary facilities: Shropshire and Staffordshire SHA
Markedly more men than women are placed in the private or voluntary sectors. Many women may be placed in facilities catering for larger numbers of men. There was no significant difference between men and women in terms of age.
The population placed is predominantly white British.
Principal psychiatric diagnoses Categories of ‘diagnosis’ were selected to reflect some of the more unusual syndromes, where lack of local capability might lead to placement in the independent sector.
Known diagnoses are shown in table 114.
‘A census day audit of mental health independent sector placements in the West Midlands’ 96 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Principal psychiatric diagnosis Number Percent
Pick's disease 1 0.4 Huntington's Chorea 7 2.8 Korsakoff's Syndrome 12 4.7 Early onset dementia 12 4.7 Acquired brain injury 21 8.3 Other organic condition 3 1.2 Schizophrenia 90 35.4 Schizo-affective disorder 7 2.8 Bi-polar disorder/affective psychosis 24 9.4 Other psychotic disorder 6 2.4 Depression 8 3.1 Anxiety disorder 2 0.8 Eating disorder 4 1.6 Personality disorder 19 7.5 Autism/Asperger's syndrome 25 9.8 Other 4 1.6 Non-specific mental illness 8 3.1 Dementia 1 0.4 Total 254 100
Table 114. Principal diagnoses of adults (under 65) placed in private/voluntary facilities: Shropshire and Staffordshire SHA
Around half of adults placed have known psychotic illnesses, and a small number have no known specific diagnosis. The remainder include people with diagnoses that may be harder to provide for within mainstream services.
Additional problems of alcohol dependence were recorded in 26 cases (10.2%) and drug dependence in 13 cases (5.1%).
Additional problems of learning disability were recorded in 67 cases (26.4%), and deafness in 4 cases (1.6%).
‘A census day audit of mental health independent sector placements in the West Midlands’ 97 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Legal status of individuals placed
Table 115 shows the legal status of adults placed in private or voluntary facilities.
Mental Health Act 1983 status Number Percent
Informal 134 52.8 Section 2 3 1.2 Section 3 31 12.2 Section 7 (Guardianship) 4 1.6 Section 25 2 0.8 Section 37 6 2.4 Section 37/41 10 3.9 Section 117 33 13.0 Don't know 31 12.2 Total 254 100
Table 115. Mental Health Act status of adults placed in private or voluntary facilities: Shropshire and Staffordshire SHA
Most individuals are placed as informal patients, or as part of arrangements following detention under Section 3. A further group are subject to formal detention under Part 2 of the Act, and an even smaller group are placed under Part 3 (forensic provisions).
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the individual placed. In 228 cases (89.8%) commissioners indicated that the placement was appropriate, in 12 cases (4.7%) the placement was not appropriate, whilst in 14 cases (5.5%) the commissioner completing the form did not know whether the placement was appropriate or not.
The placements
Table 116 indicates the sector of placements used in Shropshire and Staffordshire.
Sector Number Percent
Private 230 90.6 Voluntary 24 9.4 Total 254 100.0
‘A census day audit of mental health independent sector placements in the West Midlands’ 98 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Table 116. Sector of provision for adults under 65: Shropshire and Staffordshire SHA
It is clear that the private market dominates provision outside of the statutory agencies.
Types of placement are shown in table 117.
Type of placement (adults <65) Number Percent
Acute in-patient ward 13 5.1 Psychiatric Intensive Care Unit 4 1.6 Low secure/high dependency unit 6 2.4 Medium secure unit 20 7.9 Rehabilitation unit 27 10.6 Continuing care service 171 67.3 Psychotherapy service (in-patient) 1 0.4 Specialist eating disorder facility 3 1.2 Other service 8 3.1 CAMHS Residential Unit 1 0.4 Total 254 100.0
Table 117. Types of adult placements in private or voluntary sector: Shropshire and Staffordshire SHA.
Longer term or non-specialist units predominate in overall provision.
Types of Healthcare Commission and Commission for Social Care Inspection registration are shown in table 118.
Type of registration Number Percent
Independent hospital 64 25.2 Care home with nursing 95 37.4 Care home 95 37.4 Total 254 100.0
Table 118. Type of registration: Shropshire and Staffordshire SHA adult placements
Independent hospitals, care homes with nursing and care homes were all provided by the private and the voluntary sectors.
Placements were funded in a variety of ways. Table 119 shows the funding sources.
‘A census day audit of mental health independent sector placements in the West Midlands’ 99 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Funder of placement Number Percent
Health (PCTs) 125 49.2 Social services 60 23.6 Joint health & social services 68 26.8 Other 1 0.4 Total 254 100.0
Table 119. Placement funding source: adults placed in voluntary or private sector Shropshire and Staffordshire SHA
PCTs are funding the largest number of placements, more than twice the number funded by Social Services. Sole NHS funding was significantly more likely to underpin placements in independent hospitals, whilst sole Social Services funding was more likely for facilities described as ‘care homes’. Joint funding was used for all types of placements, although care home placements predominated.
Costs of placements
Average costs are shown in table 120.
Average weekly Maximum weekly Type of funding cost per placement cost placement (£) (£)
Health service only 1867 5600
LA Social Services 336 672 only
Joint 1182 3168
Average added cost 30.50 375 of ‘specialing’
All placements 1340 5600
Table 120. Average costs of adult placements commissioned in the private and voluntary sectors: Shropshire and Staffordshire SHA
Note: Cost information missing in 37 cases(not included)
‘A census day audit of mental health independent sector placements in the West Midlands’ 100 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Total weekly costs of all placements in the census week: £290,614
Total weekly cost to NHS funders in the census week: £249,503
Total weekly cost to LASSD funders in the census week: £48,373
If the census week is assumed to be typical, current TOTAL costs approximate £15.11 million per annum for adults under 65 years of age placed by PCTs and LASSDs in the Shropshire and Staffordshire strategic health authority area.
Health funding predominates in the high-cost placements, and health funding also underpins a greater number of placements, leading to higher overall costs to the NHS.
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether individuals placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 121.
Named Care Co- Percent District of Percent professional ordinator origin (number) consultant (number) Yes 206 81.1 193 76.0 No 21 8.3 23 9.1 Don't know 27 10.6 38 15.0 Total 254 100.0 254 100
Table 121. Individuals with Care Co-ordinator and District of origin consultant at point of census: Shropshire and Staffordshire SHA private and voluntary placements
When these figures are combined, a total of 221 out of 254 individuals placed are known to have either a named care co-ordinator, or a named District of origin consultant, or both. However, a minority do not have this formal linkage. The study was not designed to establish the robustness or otherwise of the formal links.
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each individual placement during the 12 month period preceding the census. Table 122 indicates the number who affirmed that they had received this feedback.
‘A census day audit of mental health independent sector placements in the West Midlands’ 101 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 160 (63.0) 76 (29.9) 18 (7.1) care co-ordinator Verbal report from 94 (37.0) 136 (53.5) 24 (9.4) care co-ordinator Written report from 105 (41.3) 128 (50.4) 21 (8.3) service provider Verbal report from 107 (42.1) 127 (50.0) 20 (7.9) service provider Visit to placement by 93 (36.6) 88 (34.6) 73 (28.7) commissioner Care review attended 93 (36.6) 90 (35.4) 71 (28.0) by commissioner Written carer or 19 (7.5) 208 (81.9) 27 (10.6) relative contact Verbal carer or 97 (38.2) 133 (52.4) 24 (9.4) relative contact Written patient 10 (3.9) 217 (85.4) 27 (10.6) contact Verbal patient 122 (48.0) 114 (44.9) 18 (7.1) contact 35 (13.8) 147 (57.9) 72 (28.3) Healthcare commission reports 3 (1.2) 184 (72.4) 67 (26.4) Mental Health Act Commission Report
Table 122. Feedback to commissioners: Shropshire and Staffordshire SHA private and voluntary placements (adults <65)
It must be acknowledged that there were inconsistencies between areas in the way in which the census forms were completed, and many were not completed directly by commissioners but by others in the organization. The information contained in table 13 is therefore broadly indicative only of the use of various channels of feedback.
‘A census day audit of mental health independent sector placements in the West Midlands’ 102 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Reasons for placement
Reasons given for placements are shown in table 123.
Reasons for placement Number Percent
Lack of local capacity 70 27.6 Lack of local capability 32 12.6 Other 8 3.1 Don't know 99 39.0 Most appropriate to needs 15 5.9 Family reasons 1 0.4 Resettlement project 29 11.4 Total 254 100.0
Table 123. Reasons for placements of adults under 65 years of age in the private and voluntary sectors: Shropshire and Staffordshire SHA
The largest single group of reasons are ‘not known’, but issues of capacity and capability also feature prominently in the reasons for placement.
Distance from district of origin
As the research team did not have access to home addresses of individuals placed, distances were calculated from the post-code of the PCT or Local Authority funding the placement, and from the post-code of the placement itself. This gives an approximate indication of distances involved, although in county and rural areas the margin of error in approximating ‘distance from home’ will be greater.
Of all adult placements made by organizations within the Shropshire and Staffordshire SHA, 93 (36.6%) were identified as being within the geographical catchment area of the funding PCT or LASSD; 161 (63.4%) were outside of the funder’s normal catchment area.
Average distance to placement: 39.2 miles (Range 0.8 – 228 miles)
Average distance to placements outside of PCT or LASSD catchment 55.7 miles (Range 1.8 -228 miles)
Table 124 shows the distance from area of origin according to the placement sector.
‘A census day audit of mental health independent sector placements in the West Midlands’ 103 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Distance to placement from Sector Total commissioner address Private Voluntary 0-20 miles Number 101 14 115 % within Sector 43.9% 58.3% 45.3% 21-50 miles Number 65 4 69 % within Sector 28.3% 16.7% 27.2% over 50 miles Number 64 6 70 % within Sector 27.8% 25.0% 27.6% Total Number 230 24 254 % within Sector 100.0% 100.0% 100.0%
Table 124. Distance to placement in bands by placement sector: Shropshire and Staffordshire SHA (adults up to 65 years)
Just under half of all adult placements are within 20 miles of the funding PCT or LASSD. The remainder, most of which are private sector placements, are further afield. Around a quarter of both private and voluntary sector placements are over 50 miles from the funding authority base.
Providers used by Shropshire and Staffordshire commissioners
A total of 104 establishments were used as placements for adults under 65 years of age, on the date of the census.
Of these, 65 had only one person placed with them funded by the Shropshire and Staffordshire Commissioners. Fourteen providers had 5 or more people placed with them, funded by Shropshire and Staffordshire PCTs or LASSDs on the census date. Table 125 shows the most commonly-used providers.
Provider organisation Number (%) of people placed at census date
Richmond Fellowship 21 (8.3) John Munroe Independent Hospital 20 (7.9) Extra Care Charitable Trust 11 (4.3) Nightingale Group Ltd. 8 (3.1) Mental Health Care Group 8 (3.1) Minehome Ltd. 8 (3.1) Partnerships in Care Ltd. 7 (2.8) Farescare Ltd. 7 (2.8) Groundstyle Ltd. 7 (2.8) Craegmoor Healthcare Ltd. 6 (2.4) Moorland Rehabilitation Ltd. 6 (2.4) Rethink 6 (2.4) Affinity Healthcare 5 (2.0) Care Principles Ltd. 5 (2.0)
Table 125: Most commonly used providers for adults: Shropshire and Staffordshire SHA ‘A census day audit of mental health independent sector placements in the West Midlands’ 104 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Just under half of all census day placements were provided by these 14 organisations.
Table 126 shows the numbers placed broken down according to the provider trusts responsible for normal statutory services in the Shropshire and Staffordshire SHA.
Usual statutory Mental Health Number (%) of adults placed Provider Trust in private or voluntary facilities on census date
North Staffordshire Combined 66 (26.0) Healthcare NHS Trust Shropshire County PCT 72 (28.3) South Staffordshire Healthcare 65 (25.6) NHS Trust Not given 51 (20.1)
Table 126. Numbers placed by usual statutory provider
‘A census day audit of mental health independent sector placements in the West Midlands’ 105 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Older people aged 65 years and over
Gender, age and ethnicity of older people placed
Demographic details are shown in table 127.
Older people in private/voluntary Summary statistics sector Gender Number (%) male 52 (32.5) Number (%) female 107 (66.9)
Age Mean age in years, range of 77.1 (65-99) ages
Ethnicity (number %) 135 (84.4) White British 1 (0.6) Bangladeshi 24 (15.0) Missing information
Table 127. Gender, age and ethnicity of older people (65 and over) placed in private/voluntary facilities: Shropshire and Staffordshire SHA
More women than men are placed in the private or voluntary sectors in the older age group. However, this reflects the population proportions.
Principal psychiatric diagnoses
Categories of ‘diagnosis’ were selected to reflect some of the more unusual syndromes, where lack of local capability might lead to placement in the independent sector. Older people with organic illnesses funded solely by Social Services were excluded.
Known diagnoses are shown in table 128.
‘A census day audit of mental health independent sector placements in the West Midlands’ 106 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Principal psychiatric diagnosis Number Percent
Huntington's Chorea 2 1.3 Korsakoff's Syndrome 2 1.3 Early onset dementia 13 8.1 Acquired brain injury 7 4.4 Other organic condition 9 5.6 Schizophrenia 41 25.6 Schizo-affective disorder 2 1.3 Bi-polar disorder/affective psychosis 13 8.1 Other psychotic disorder 3 1.9 Depression 31 19.4 Anxiety disorder 12 7.5 Personality disorder 4 2.5 Other 1 0.6 Non-specific mental illness 12 7.5 Dementia 8 5.0 Total 160 100
Table 128. Principal diagnoses of older people (65 years and over) placed in private/voluntary facilities: Shropshire and Staffordshire SHA
Over a third of older people placed have known psychotic illnesses, and a further quarter have no known specific diagnosis.
Additional problems of alcohol dependence were recorded in 2 cases only and drug dependence in no cases.
Additional problems of learning disability were recorded in 10 cases, and deafness in 4 cases. However, in a majority of cases, these additional factors were recorded as ‘not known’.
Legal status of older individuals placed
Table 129 shows the legal status of older people placed in private or voluntary facilities.
‘A census day audit of mental health independent sector placements in the West Midlands’ 107 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Mental Health Act 1983 status Number Percent
Informal 71 44.4 Section 2 2 1.3 Section 3 5 3.1 Section 117 18 11.3 Don't know 64 40.0 Total
Table 129. Mental Health Act status of older people placed in private or voluntary facilities: Shropshire and Staffordshire SHA
Most individuals are placed as informal patients, or as part of Section 117 arrangements following detention under Section 3. The proportion where legal status was not known is substantial.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the older person placed. In 137 cases (85.6%) commissioners indicated that the placement was appropriate, in one case the placement was not appropriate, whilst in 22 cases (13.8%) the commissioner completing the form did not know whether the placement was appropriate or not. (This is a higher proportion of ‘not known’ responses than for adults under 65.)
The placements
Table 130 indicates the sector of placements used for older people in Shropshire and Staffordshire.
Sector of placement Number Percent
Private 139 86.9 Voluntary 21 13.1 Total 160 100
Table 130. Sector of provision for older people aged 65 and over: Shropshire and Staffordshire SHA
The dominance of private over voluntary provision is as marked as in the adult sector.
Types of placement are shown in table 131.
‘A census day audit of mental health independent sector placements in the West Midlands’ 108 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Type of placement Number Percent
Acute in-patient ward 1 0.6 Rehabilitation unit 4 2.5 Continuing care service 155 96.9 Total 160 100
Table 131. Types of placements for older people in private or voluntary sector: Shropshire and Staffordshire SHA.
Continuing care units predominate in overall provision.
Types of registration with the Healthcare Commission or Commission for Social Care Inspection are shown in table 132.
Type of registration Number Percent
Independent hospital 8 5.0 Care home with nursing 111 69.4 Care home 41 25.6 Total 160 100
Table 132. Type of registration: Shropshire and Staffordshire SHA placements for older people
All but four of the voluntary sector placements were in premises designated as ‘care homes with nursing’.
Placements were funded in a variety of ways. Table 133 shows the funding sources.
Funder(s) Number of Percent placements Health 38 23.8 Social Services 113 70.6 Joint 8 5.0 Total 159 99.4
Table 133. Placement funding source: older people placed in voluntary or private sector Shropshire and Staffordshire SHA
Social Services authorities are the sole funder for a far larger proportion of placements than is the case in the adult sector. Joint funding arrangements are markedly less common. ‘A census day audit of mental health independent sector placements in the West Midlands’ 109 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Costs of placements
Average costs are shown in table 134.
Average weekly Maximum weekly Type of funding cost per placement cost placement (£) (£)
Health service only 627 2000
LA Social Services 358 450 only
Joint 666 1360
All placements 413 2000
Table 134. Average costs of placements for older people commissioned in the private and voluntary sectors: Shropshire and Staffordshire SHA
Note: Cost information missing in 19 cases
Total weekly costs of all placements in the census week: £58,174
Total weekly cost to NHS funders in the census week : £16,212
Total weekly cost to LASSD funders in the census week: £43,176
If the census week is assumed to be typical, current TOTAL costs approximate £3.03 million per annum for older people aged 65 years of age and over, placed by PCTs and LASSDs in the Shropshire and Staffordshire strategic health authority area.
For older people Social Services fund far more placements numerically, and also bear the highest overall cost burden.
‘A census day audit of mental health independent sector placements in the West Midlands’ 110 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether older people placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 135.
Named Care co- Percent District of origin Percent professional ordinator consultant (Number) (Number) Yes 62 38.8 60 37.5 No 60 37.5 34 21.3 Don't know 38 23.8 66 41.3 Total 160 100 160 100
Table 135. Older people with Care Co-ordinator and District of origin consultant at point of census: Shropshire and Staffordshire SHA private and voluntary placements
When these figures are combined, a total of 77 (48.1%) out of 160 individuals placed have either a named care co-ordinator, or a named District of origin consultant, or both. However, a minority (23, 14.4%) do not have this formal linkage.
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each older person placed, during the 12 month period preceding the census date.
Table 136 indicates the number who affirmed that they had received this feedback.
In a large number of cases, those completing the census forms did not have access to information about this type of feedback, explaining the substantial number of ‘not known’ responses.
‘A census day audit of mental health independent sector placements in the West Midlands’ 111 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 50 (31.3) 89 (55.6) 21 (13.1) care co-ordinator Verbal report from 38 (23.8) 101 (63.1) 21 (13.1) care co-ordinator Written report from 19 (11.9) 114 (71.3) 27 (16.9) service provider Verbal report from 77 (48.1) 64 (40.0) 19 (11.9) service provider Visit to placement by 41 (25.6) 74 (46.3) 45 (28.1) commissioner Care review attended 41 (25.6) 81 (50.6) 38 (23.8) by commissioner Written carer or 12 (7.5) 121 (75.6) 27 (16.9) relative contact Verbal carer or 59 (36.9) 78 (48.8) 23 (14.4) relative contact Written patient 17 (10.6) 120 (75.0) 23 (14.4) contact Verbal patient 86 (53.8) 60 (37.5) 14 (8.8) contact 2 (1.3) 110 (68.8) 48 (30.0) Healthcare commission reports 1 (0.6) 115 (71.9) 44 (27.5) Mental Health Act Commission Report
Table 136. Feedback to commissioners: Shropshire and Staffordshire SHA private and voluntary placements of older people
Reasons for placement
Reasons given for placements are shown in table 137.
‘A census day audit of mental health independent sector placements in the West Midlands’ 112 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Reasons for placements Number Percent
Lack of local capacity 15 9.4 Lack of local capability 6 3.8 Most appropriate to needs 15 9.4 Family reasons 5 3.1 Resettlement project 27 16.9 Other 8 5.0 Don't know 84 52.5 Total 160 100
Table 137. Reasons for placements of older people aged 65 years and over in the private and voluntary sectors: Shropshire and Staffordshire SHA
Many placements are likely to be long-standing, and the original reasons for placement may be unavailable.
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as for adults. Of all placements of older people made by organizations within the Shropshire and Staffordshire SHA, 54 (33.8%) were identified as being within the geographical catchment area of the funding PCT or LASSD; 106 (66.3%) were outside of the funder’s normal catchment area. This is a similar proportion of older people placed within the normal funder’s catchment area as for adults under 65 years.
Average distance to placement: 20.1 miles (Range 0.8 – 152 miles)
Average distance to placements outside of PCT or LASSD catchment 26.8 miles (Range 4.4 - 152 miles)
Providers used by Shropshire and Staffordshire commissioners
A total of 72 establishments were used as placements for older people, on the date of the census.
Of these, 47 had only one person placed with them funded by the Shropshire and Staffordshire Commissioners. Only six providers had 5 or more people placed with them, funded by Shropshire and Staffordshire PCTs or LASSDs on the census date. Table 138 shows the most commonly-used providers.
Provider organisation Number (%) of people placed at census date
Extra Care Charitable Trust 19 (11.9) Minehome Ltd. 13 (8.1) Grangemoor Care Homes 12 (7.5) John Munroe Independent 7 (4.4) Hospital Restful Homes Ltd 5 (3.1) Standon Hall Home Ltd 5 (3.1)
Table 138: Most commonly used providers for older people: Shropshire and Staffordshire SHA
The provision is generally dispersed with most providers having very small numbers.
Table 139 shows the numbers placed broken down according to the provider trusts responsible for normal statutory services in the Shropshire and Staffordshire SHA.
Usual statutory Mental Health Number of out- Percent Provider Trust of-sector placements North Staffordshire Combined 27 16.9 Healthcare NHS Trust Shropshire County PCT 12 7.5 South Staffordshire 40 25.0 Healthcare NHS Trust Total 79 49.4 Information not provided 81 50.6 Total 160 100.0
Table 139. Numbers of older people placed on census date, and usual statutory provider
South Staffordshire Healthcare NHS Trust is the usual statutory provider for the greatest number of placements of older people made outside of the statutory sector.
‘A census day audit of mental health independent sector placements in the West Midlands’ 114 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Children and adolescents (in CAMHS)
Gender, age and ethnicity of children and adolescents placed
Thirty-nine users of child and adolescent mental health services in the voluntary and private sectors (including placements in residential schools for ‘mental health’ reasons) were identified in the census in the Shropshire and Staffordshire SHA. Demographic details are shown in table 140.
Children and adolescents in Summary statistics private/voluntary sector
Gender Number male 24 (61.5) Number female 15 (38.5)
Age Mean (years), range 15 (10-19)
Ethnicity (number %) White British 36 (92.3%) Irish 1 (2.6%) Information not provided 2 (5.1%)
Table 140. Gender, age and ethnicity of children and adolescents placed in private/voluntary facilities: Shropshire and Staffordshire SHA
Principal psychiatric diagnoses
Known diagnoses are shown in table 141.
Known principal diagnosis Number Percent
Acquired brain injury 2 5.1 Schizophrenia 2 5.1 Other neurotic disorder 1 2.6 Eating disorder 2 5.1 Autism/Asperger's syndrome 16 41.0 Other 15 38.5 Total 38 100.0
Table 141. Principal diagnoses of children and adolescents placed in private/voluntary facilities: Shropshire and Staffordshire SHA
‘A census day audit of mental health independent sector placements in the West Midlands’ 115 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Almost half of the young people are diagnosed with autism or Asperger’s syndrome. No additional problems of drug dependence, alcohol dependence or deafness were recorded. In 8 cases additional problems of learning disability were recorded
Legal status of young people placed
Table 142 shows the legal status of the young people placed in private or voluntary facilities.
Legal status of young people in Number Percent private/voluntary provision Informal 11 28.2 Section 3 Mental Health Act 21 53.8 Don't know 6 15.4 Children Act Provision 1 2.6 Total 39 100.0
Table 142. Mental Health Act status of children and adolescents placed in private or voluntary facilities: Shropshire and Staffordshire SHA
The largest group (21 young people) are detained under Section 3 of the Mental Health Act.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the young person placed. In 34 cases the placement was said to be appropriate, in 2 cases it was not appropriate, and in 3 cases the response was ‘don’t know’.
The placements
Table 143 indicates the sector of placements used for young people in Shropshire and Staffordshire.
Sector Number Percent
Private 35 89.7 Voluntary 4 10.3 Total 39 100.0
Table 143. Sector of provision for children and adolescents: Shropshire and Staffordshire SHA
‘A census day audit of mental health independent sector placements in the West Midlands’ 116 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Most young people are placed within the private sector.
Types of placement are shown in table 144.
Type of placement Number Percent
Psychiatric Intensive Care Unit 1 2.6 Rehabilitation unit 2 5.1 Continuing care service 15 38.5 Specialist eating disorder facility 2 5.1 Specialist Residential School 12 30.8 CAMHS Residential Unit 6 15.4 Other service 1 2.6 Total 39 100.0
Table 144. Types of placements for young people in private or voluntary sector: Shropshire and Staffordshire SHA.
Placements were funded in a variety of ways. Table 145 shows the funding sources.
Funder(s) Number of Percent placements Health 7 17.9 Social Services 1 2.6 Joint health & Social Services 11 28.2 3-way PCT, SSD & Education 12 30.8 PCT & Education 7 17.9 Other 1 2.6 Total 39 100
Table 145. Placement funding source: young people placed in voluntary or private sector Shropshire and Staffordshire SHA
Joint funding arrangements underpin over three-quarters of all placements.
‘A census day audit of mental health independent sector placements in the West Midlands’ 117 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Costs of placements
Average costs are shown in table 146.
Average weekly Maximum weekly Funder cost per placement cost placement (£) (£)
Health service 1377 5366
Social Services 869 4200
Health and SSDs 2340 5366
Table 146. Average costs to NHS and LASSDs of placements for young people commissioned in the private and voluntary sectors: Shropshire and Staffordshire SHA
Note: complete cost information was only returned in 33 cases. No LEA cost information was available.
Total NHS + SSD weekly costs of all 33 placements in the census week: £77,210
Total weekly cost to NHS funders in the census week: £48,204
Total weekly cost to SSD funders in census week £29,547
For the 33 CAMHS cases returned, the annual NHS + SSD costs are approximately £4.02 million. LEA costs are additional to this.
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether young people placed in private or voluntary facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 147.
Named Care co- Percent District of origin Percent professional ordinator consultant (Number) (Number) Yes 37 94.9 31 79.5 No 1 2.6 3 7.7 Don’t know 1 2.6 5 12.8 Total 39 100 39 100
‘A census day audit of mental health independent sector placements in the West Midlands’ 118 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Table 147. Children and adolescents with Care Co-ordinator and District of origin consultant at point of census: Shropshire and Staffordshire SHA private and voluntary placements
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each young person placed, during the 12 month period preceding the census date. Table 148 indicates the number who affirmed that they had received this feedback.
Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 22 (56.4) 15 (38.5) 2 (5.1) care co-ordinator Verbal report from 22 (56.4) 15 (38.5) 2 (5.1) care co-ordinator Written report from 9 (23.1) 28 (71.8) 2 (5.1) service provider Verbal report from 6 (15.4) 30 (76.9) 3 (7.7) service provider Visit to placement by 4 (10.3) 31 (79.5) 4 (10.3) commissioner Care review attended 5 (12.8) 29 (74.4) 5 (12.8) by commissioner Written carer or 5 (12.8) 32 (82.1) 2 (5.1) relative contact Verbal carer or 6 (15.4) 31 (79.5) 2 (5.1) relative contact Written patient 1 (2.6) 35 (89.7) 3 (7.7) contact Verbal patient 3 (7.7) 33 (84.6) 3 (7.7) contact 23 (59.0) 12 (30.8) 4 (10.3) Healthcare commission reports 0 35 (89.7) 4 (10.3) Mental Health Act Commission Report
Table 148. Feedback to commissioners: Shropshire and Staffordshire SHA private and voluntary placements of children and adolescents
Reasons for placement
Reasons given for placements are shown in table 149.
‘A census day audit of mental health independent sector placements in the West Midlands’ 119 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Reason for placement Number Percent
Lack of local capacity 10 25.6 Lack of local capability 3 7.7 Most appropriate to needs 1 2.6 Don't know 25 64.1 Total 39 100.0
Table 149. Reasons for placements of children and adolescents in the private and voluntary sectors: Shropshire and Staffordshire SHA
Commissioners responding to the census were not aware of reasons for the placement in a majority of cases.
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as for adults and older people. Of the thirty-nine placements for children and adolescents made by organizations within the Shropshire and Staffordshire SHA, 11 (28.2%) were within the usual boundaries of the funding authority.
Average distance to placement (39 cases): 45.5 miles (Range 3 – 162miles)
Providers used for children and adolescents by Shropshire and Staffordshire commissioners
A total of 22 providers were used for the 39 placements. Fifteen providers had only one placement from Shropshire and Staffordshire on the census day.
The 7 organisations providing more than one placement on the census day are listed in table 150.
Provider organisation Number (%) of young people placed at census date
Young Options 7 (17.9) New Horizons 4 (10.3) Key Attachment Centre 4 (10.3) Hunterscombe Hospitals 3 (7.7) Bryn Melyn Group 2 (5.1) Pegasus Schools 2 (5.1) The Priory Group 2 (5.1)
‘A census day audit of mental health independent sector placements in the West Midlands’ 120 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 150. Private and voluntary sector providers used for children and adolescents: Shropshire and Staffordshire STA
Table 151 shows the numbers of young people placed broken down according to the provider trusts responsible for normal statutory services in the Shropshire and Staffordshire SHA.
Usual statutory Mental Health Number (%) of young people Provider Trust placed in private or voluntary facilities on census date
North Staffordshire Combined 5 (12.8) Healthcare NHS Trust Shropshire County PCT 24 (61.5) South Staffordshire Healthcare NHS Trust 10 (25.6)
Table 151. Numbers of children and adolescents placed and usual statutory provider
Shropshire County PCT is the usual statutory provider for the greatest number of placements made outside of the statutory sector, for young people.
‘A census day audit of mental health independent sector placements in the West Midlands’ 121 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Forensic placements (special commissioning) funded by PCTs in Shropshire and Staffordshire
Gender, age and ethnicity of forensic patients placed
Sixteen forensic placements were identified in the census in the Shropshire and Staffordshire SHA. Demographic details are shown in table 152.
Forensic patients in Summary statistics private/voluntary sector
Gender Number (%) male 11 (68.8) Number (%) female 5 (31.3)
Age Mean age years (range) 33 (19-69)
Ethnicity (number %) White British 15 (93.8) Black Caribbean 1 (6.3)
Table 152. Gender, age and ethnicity of individuals placed in private/voluntary forensic facilities: Shropshire and Staffordshire SHA
Principal psychiatric diagnoses
Known diagnoses are shown in table 153.
Diagnosis (forensic patients) Number Percent
Schizophrenia 7 43.8 Schizo-affective disorder 1 6.3 Personality disorder 7 43.8 Autism/Asperger's syndrome 1 6.3 Total 16 100.0
Table 153. Principal diagnoses of individuals placed in private/voluntary forensic facilities: Shropshire and Staffordshire SHA
Half of the patients in forensic placements are diagnosed with psychotic illnesses. Three people were identified as having additional problems of alcohol dependence, and a further three had additional problems of learning disability. There were no identified cases of drug dependence. One person was identified as deaf.
‘A census day audit of mental health independent sector placements in the West Midlands’ 122 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Legal status of forensic patients placed
Table 154 shows the legal status of the sixteen people placed in private or voluntary forensic facilities.
Mental Health Act status Number Percent
Informal 1 6.3 Section 3 2 12.5 Section 37 4 25.0 Section 37/41 8 50.0 Don't know 1 6.3 Total 16 100.0
Table 154. Mental Health Act status of individuals placed in private or voluntary forensic facilities: Shropshire and Staffordshire SHA
The largest group (8 individuals) are detained under Section 37/41 of the Act.
Suitability of placement
Commissioners were asked to indicate in broad terms whether the current placement was appropriate to the needs of the individual placed. In 12 cases the placement was said to be appropriate, whilst in 4 cases it was not appropriate.
The placements
Table 155 indicates the sector of forensic placements in Shropshire and Staffordshire.
Sector of placement Number Percent
Private 15 93.8 Voluntary 1 6.3 Total 16 100
Table 155. Sector of forensic provision: Shropshire and Staffordshire SHA
Most placements are within the private sector.
Types of placement are shown in table 156.
‘A census day audit of mental health independent sector placements in the West Midlands’ 123 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Type of placement Number Percent
Medium secure unit 12 75.0 Rehabilitation unit 2 12.5 Continuing care service 1 6.3 Other service 1 6.3 Total 16 100.0
Table 156. Types of forensic placements in private or voluntary sector: Shropshire and Staffordshire SHA.
The majority of placements were described as medium secure units.
Table 157 shows the funding sources for the 16 forensic placements.
Funder for placement Number Percent
Health 15 93.8 Social services 1 6.3 Total 16 100.0
Table 157. Placement funding source: forensic placements in voluntary or private sector Shropshire and Staffordshire SHA
All but one of the placements were funded by the NHS.
Costs of placements
Average costs are shown in table 158. Cost information was returned in all 16 cases.
‘A census day audit of mental health independent sector placements in the West Midlands’ 124 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Average weekly Maximum weekly Type of funding cost per placement cost placement (£) (£)
Health service only 3131 4018 (n=15) Social Services 408 408 (n=1) All placements 2961 4018
Table 158. Average costs of forensic placements commissioned in the private and voluntary sectors: Shropshire and Staffordshire SHA
Total weekly costs of all 16 placements in the census week: £47,378
Total weekly cost to NHS funders in the census week: £46,970
Total SSD costs in census week £ 408
For the 16 forensic placements, the annual total cost is approximately £2.5 million.
Linkage to CPA mechanisms
Commissioners completing the census forms were asked whether individuals placed in private or voluntary forensic facilities had a current named care co-ordinator, and a current consultant at their District of origin.
Replies are shown in table 159.
‘A census day audit of mental health independent sector placements in the West Midlands’ 125 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Named Care co- Percent District of Percent professional ordinator origin (Number) consultant (Number) Yes 16 100 9 56.3 No 0 0 6 37.5 Don’t know 0 0 1 6.3 Total 16 100 16 100
Table 159. Forensic patients with Care Co-ordinator and District of origin consultant at point of census: Shropshire and Staffordshire SHA private and voluntary placements
Commissioners were asked to indicate (from a checklist) the types of feedback they had received about each individual placed, during the 12 month period preceding the census date. Table 160 indicates the number who affirmed that they had received this feedback.
Sources of Feedback No feedback Don’t know if feedback received received feedback Number (%) Number (%) received Number (%)
Written report from 15 (93.8) 1 (6.3) 0 care co-ordinator Verbal report from 3 (18.8) 13 (81.3) 0 care co-ordinator Written report from 15 (93.8) 1 (6.3) 0 service provider Verbal report from 2 (12.5) 14 (87.5) 0 service provider Visit to placement by 8 (50.0) 7 (43.8) 1 (6.3) commissioner Care review attended 9 (56.3) 7 (43.8) 0 by commissioner Written carer or 1 (6.3) 15 (93.8) 0 relative contact Verbal carer or 2 (12.5) 14 (87.5) 0 relative contact Written patient 1 (6.3) 15 (93.8) 0 contact Verbal patient 9 (56.3) 7 (43.8) 0 contact 14 (87.5) 2 (12.5) 0 Healthcare commission reports 0 16 (100) 0 Mental Health Act Commission Report
Table 160. Feedback to commissioners: Shropshire and Staffordshire SHA private and voluntary forensic placements
‘A census day audit of mental health independent sector placements in the West Midlands’ 126 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Reports from care co-ordinators and service providers, and Healthcare Commission reports, appear to be the principal sources of feedback.
Reasons for placement
Reasons given for placements are shown in table 161.
Reason for placement in Number Percent the private or voluntary sector Lack of local capacity 6 37.5 Lack of local capability 10 62.5 Total 16 100.0
Table 161. Reasons for forensic placements in the private and voluntary sectors: Shropshire and Staffordshire SHA
Distance from district of origin
Approximate distances of placements from the person’s home area were calculated as described for all placements. Of the sixteen forensic placements made by organizations within the Shropshire and Staffordshire SHA, none were within the usual boundaries of the funding authority.
Average distance to placement: 95.2 miles (Range 17 – 200 miles)
Providers used for forensic placements by Shropshire and Staffordshire commissioners
A range of units is used in the forensic sector. All providers are listed in table 162.
Provider unit/ organisation Number Percent
Affinity Healthcare 2 12.5 Craegmoor Healthcare Ltd 2 12.5 Blenheim Health Care Ltd 2 12.5 Highfield Care Homes Ltd 1 6.3 Anchor Trust 1 6.3 St Andrews Hospital 1 6.3 Partnerships In Care Ltd 4 25.0 Florence Nightingale Hospitals Ltd 1 6.3 Care Principles Ltd 2 12.5 Total 16 100.0
‘A census day audit of mental health independent sector placements in the West Midlands’ 127 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)
Table 162. Providers used for forensic placements: Shropshire and Staffordshire SHA
Table 163 shows the numbers of forensic placements broken down according to the provider trusts responsible for normal statutory services in the Shropshire and Staffordshire SHA.
Usual statutory Mental Health Number (%) of forensic Provider Trust placements in private or voluntary facilities on census date
North Staffordshire Combined 5 (31.3) Healthcare NHS Trust Shropshire County PCT 8 (50.0) South Staffordshire Healthcare 2 (12.5) NHS Trust No information 1 (6.3)
Table 163. Numbers of forensic placements and usual statutory provider
Shropshire County PCT is the usual statutory provider for the greatest number of forensic placements made outside of the statutory sector.
‘A census day audit of mental health independent sector placements in the West Midlands’ 128 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Appendix 7 – Data providers
Social Services Departments (x 14) • Walsall PC • Birmingham • Wednesbury & West Bromwich PCT • Coventry • Wolverhampton City PCT • Dudley • Wyre Forest PCT • Herefordshire • Sandwell Others (x 1) • Shropshire • Specialised Commissioning Services • Solihull Agency • Staffordshire • Stoke on Trent • Telford & Wrekin • Walsall • Warwickshire • Worcestershire • Wolverhampton
Primary Care Trusts (x 30) • Burntwood, Litchfield & Tamworth PCT • Cannock Chase PCT • Coventry PCT • Dudley Beacon & Castle PCT • Dudley South PCT • Eastern Birmingham PCT • East Staffordshire PCT • Heart Of Birmingham PCT • Herefordshire PCT • Newcastle under Lyme PCT • North Birmingham PCT • North Stoke PCT • North Warwickshire PCT • Oldbury & Smethwick PCT • Redditch & Bromsgrove PCT • Rowley Regis & Tipton PCT • Rugby PCT • Shropshire County PCT • Solihull PCT • South Birmingham PCT • South Stoke PCT • South Warwickshire PCT • South Western Staffordshire • South Worcestershire PCT • Staffordshire Moorlands PCT • Telford & Wrekin PCT
‘A census day audit of mental health independent sector placements in the West Midlands’ 129 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Appendix 8 – NHS Provider Trusts in West Midlands (x 13)
• Birmingham and Solihull MH NHS Trust • Coventry Teaching PCT • Dudley Beacon and Castle PCT • Herefordshire PCT • North Staffordshire Combined Healthcare NHS Trust • North Warwickshire PCT • Sandwell MH NHS and Social Care Trust • Shropshire County PCT • South Staffordshire Healthcare NHS Trust • South Warwickshire PCT • Walsall Teaching PCT • Worcestershire Mental Health Partnership NHS Trust • Wolverhampton City PCT
Appendix 9 – Data collection proforma
Mental Health Social Work Research Unit Health & Social Care Advisory Service School of Psychiatry & Behavioural Sciences Emerson Business Centre
th 5th Floor, St James's House 12 Floor, Mathematics Building Pendleton Way University of Manchester Pendleton Oxford Road Manchester M6 5FW Manchester M13 9PL
Audit of non-statutory sector placements in the West Midlands As you will be aware we have been commissioned by the West Midlands NIMHE Regional Development Centre to undertake a census of psychiatric placements in the independent and voluntary sectors. We are asking you to provide details about placements, individuals and funding arrangements. This will provide important information that will support strategic commissioning across the West Midlands.
Instructions on how to record the information we require are provided overleaf. However, if you have any queries about how to complete any of the questionnaires, please contact Indhu Sharma on 0161 275 5221 or by email on ([email protected]).
Confidentiality All information will be treated confidentially and all forms anonymised. This page will be detached and stored separately from the rest of the form. This audit has ethical approval from the NW MREC and the University of Manchester Faculty of Medicine.
Name of person completing the form
The patient’s PCT or SSD
Telephone number of person completing this form (for any queries) Unique identifier for individual in placement (NHS number, or similar, to enable you to identify the person)
‘A census day audit of mental health independent sector placements in the West Midlands’ 131 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) INSTRUCTIONS FOR COMPLETION OF FORM
Use one form for each patient meeting the criteria below
Individuals in placements that are:
• placements in facilities registered with the Healthcare Standards Commission as Independent Hospitals or Care Homes including Care Homes with Nursing (i.e. private and voluntary sector placements only)
• include Forensic and CAMHS placements meeting the above criteria
• include placements outside and inside the geographical boundary of the commissioner
• all age groups except people over 65 with organic illnesses funded solely by Local Authority
And who fall into one of the following groups:
• mental illnesses and personality disorders OR • early onset dementias (e.g. Korsakoff’s Syndrome, Pick’s Disease) OR • acquired brain injuries (where paid for from a mental health budget) OR • autism / Asperger’s syndrome
NB – Do not include people with a sole diagnosis of learning disability or people with a primary drug and alcohol problem
Include all people admitted and discharged on the day of the census (28th June 2004)
For all questions, please respond by putting the appropriate number in the boxes (unless stated otherwise)
For example, if patient has a diagnosis of ‘schizophrenia’ put 07 in the two boxes underneath ‘principal psychiatric diagnosis’.
For ‘costs’ enter actual costs for the week of census.
‘A census day audit of mental health independent sector placements in the West Midlands’ 132 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Patient’s PCT Principal psychiatric diagnosis (leave these boxes empty)
______01 = Pick’s disease 02 = Huntington’s Chorea Patient’s Local Authority 03 = Korsakoff’s Syndrome 04 = Early onset dementia (type unspecified) (leave these boxes empty) 05 = Acquired brain injury ______06 = Other organic condition (specify) ______When did the placement begin 07 = Schizophrenia 08 = Schizo-affective disorder (Enter date of admission) 09 = Bi-polar disorder / affective psychosis 10 = Other psychotic disorder (specify) ______D D M M Y 11 = Depression (not psychotic) Y 12 = Anxiety disorder Gender 13 = Other neurotic disorder (specify) 1 = Male ______2 = Female 14 = Eating disorder Age 15 = Personality disorder (Enter age in boxes) 16 = Autism/ Asperger’s syndrome 17 = Other (specify) ______Ethnicity ______Please select one of the following 16 groups ______White 1 = British 2 = Irish Does individual have additional problems of: 3 = Any other White background, please specify ______Mixed Alcohol dependence 4 = White and Black Caribbean 5 = White and Black African 1 = Yes , 2 = No, 3 = Don’t know 6 = White and Asian 7 = Any other Mixed background, please specify Drug dependence ______1 = Yes, 2 = No, 3 = Don’t know Asian or Asian British 8 = Indian Deafness 9 = Pakistani 1 = Yes, 2 = No, 3 = Don’t know 10 = Bangladeshi 11 = Any other Asian background, please specify Learning disability ______1 = Yes, 2 = No, 3 = Don’t know Black or Black British 12 = Caribbean Is the placement appropriate to the current 13 = African needs of the person? 14 = Any other Black background, please specify 1 = Yes, 2 = No, 3 = Don’t know ______Chinese or other ethnic group Comments______15 = Chinese ______16 = Any other, please specify ______
‘A census day audit of mental health independent sector placements in the West Midlands’ 133 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Does the person currently have: Mental Health Act status of individual a named Care Co-coordinator? 1 = Yes, 2 = No, 3 = Don’t know 01 = Informal 02 = Section 2 Comments______03 = Section 3 ______04 = Section 4 ______05 = Section 5(2) 06 = Section 5(4) 07 = Section 7 (Guardianship) a named consultant at District of origin? 08 = Section 25 1 = Yes, 2 = No, 3 = Don’t know 09 = Section 37 10 = Section 37/4 Comments______11 = Section 38 ______12 = Section 117 ______13 = Other (specify) ______14 = Don’t know In respect of this person which of the following types of feedback about the Which of the following most accurately placement have you had in the past twelve describes the type of placement months (enter a number for each): 1 = Yes, 2 = No, 3 = Don’t know 01 = Acute in-patient ward 02 = Psychiatric Intensive Care Unit Written report by the CPA co-coordinator 03 = Low secure/high dependency unit 04 = Medium secure unit Verbal report by the CPA co-coordinator 05 = Rehabilitation unit 06 = Continuing care unit Written report by the service provider 07 = Psychotherapy unit 08 = Specialist eating disorder unit Verbal report by the service provider 09 = Specialist mother and baby unit 10 = Women only unit (specify) A commissioner has personally visited the ______person in their placement 11 = Other unit (specify) ______A commissioner has personally attended a ______care review Who funds the placement? Written carer or relative contact 1 = Health Verbal carer or relative contact 2 = Social services 3 = Joint health & social services Written patient contact 4 = Other (e.g. dowry funded, specify) ______Verbal patient contact Cost per week (round up to nearest £) to Healthcare Commission or Commission for Social Care Reports (Enter actual amount in boxes)
Mental Health Act Commission Report(s)
Health £ Other feedback (specify) -
______Social services £ ______
______
‘A census day audit of mental health independent sector placements in the West Midlands’ 134 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Do costs include any variable element e.g. for providing additional care (e.g. 1 = Private (for profit) ‘specialing’) 2 = Voluntary/Charitable 1 = Yes, 2 = No, 3 = Don’t know 3 = Don’t know
If ‘yes’, indicate weekly amount that is variable Was the placement due to (Enter actual amount in boxes) 1 = Lack of local capacity £ 2 = Lack of local capability 3 = Other (specify) ______Comments______4 = Don’t know ______Are there other groups of clients not covered ______in this study that it would be useful to have ______similar strategic information about? ______Is the placement within the geographical ______boundaries of the funding PCT or SSD? ______1 = Yes 2 = No 3= Don’t know Other comments
Name of organization providing placement ______(Leave boxes empty) ______
______
______Address of provider unit where individual is ______placed (Leave boxes empty) ______
______
______
______Finally, we are gathering examples of good ______practice in this area in order to share across
with commissioning colleagues. Would you Postcode of placement (to track distance be willing to share copies of any policies or away from area of origin) procedures that assist you in this area of
work? ______
1 = Yes Type of National Care Standards 2 = No Commission registration
1 = Independent hospital
2 = Care home with nursing
3 = Care home 4 = Other (specify) ______5 = Not known
Sector
‘A census day audit of mental health independent sector placements in the West Midlands’ 135 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005)